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What might happen when you take lots of medicines...
What might happen when you take lots of medicines...
One of our uncles died of liver cirrhosis ten years back. He never touched alcohol in his life. He didn't have any viral infection to cause this. He didn't have diabetes, heart problems and he was not obese. Actually there was no reason that doctors could identify that might have caused this condition in him.
But, when they learned that he took lots and lots of medicines even for small ailments like headaches, stomachaches, sleeplessness, they realized reaction to drugs could have caused his condition. He used to take them even as a preventive measure in anticipation of health conditions! Because he was a medical store in-charge of a hospital and he had almost all the medicines at his disposal! I still remember the big blue plastic box in his cupboard he used to keep his medicines in.
My mother used to suffer from several ailments. Diabetes ( sometimes hypoglycemia) , BP, arthritis, osteoporosis, bronchial asthma, oedema, severe anemia, indigestion, sciatica, fungal infection of fingers and toes because of diabetes despite taking several precautions, frequent lung, dental and other infections, weakness because of old age, irregular heart beat, pericardial effusion and in the end brain stroke.
Doctors used to prescribe lots of medicines for her*. One body, multiple drugs: It can be a recipe for disaster! The risk increases with age. And my mother was old and frail! I used to wonder what might happen if she took several medicines for all those conditions mentioned above. I even discussed this with doctors and pleaded with them to prescribe medicines for her only if they're absolutely necessary. I used to ask them to tell me what they were prescribing and why she needed them. And I gave her medicines only that were necessary for her survival.
*When a person 's prescribed several different medications at once in order to treat one or multiple health conditions—the phenomenon is known as polypharmacy. (4)
While giving all those medicines to her ... these things crossed my mind several times...
These are chemicals! Although tested for human safety, clinical researchers usually weigh pros and cons and select the ones whose positives outweigh negatives. But still there will be negatives - what we call side effects. Despite these ill effects we use them because they are necessary for the survival of patients or to prolong their lives. Taking medicines or drugs is a necessary evil in such cases!
And the most important thoughts that disturbed me were ... when people take several medicines like my mother used to ... they can ...
1. Interact with one another
2. produce over dose of a drug because too much of one drug remains in your system because of the interactions
2. reduce or increase the potency of one another if they act in opposite or similar ways
3. nullify one another's potency if one drug can’t be absorbed or metabolized properly
4. produce other toxic and harmful products after reacting with one another inside human bodies
5. interfere with the patient's normal metabolic processes
6. cause damage to body organs
7. cause several other severe health conditions as a result of the above processes
-and this one is a positive one-
8. successfully suppress an existing health condition and help us find a new cure for diseases that don't have medicines yet!
These thoughts of mine have solid base as I know about the research going on in the clinical field ( now I can understand why they say ignorance is a bliss. At least you don't have to worry about these things in the beginning and can have mental peace but only up to a certain extent. When once you and your family members and friends start suffering severely because of your ignorance, the saying sails out through the window . Although we worry a lot because of the knowledge we have, we can take precautions and keep ourselves and our loved ones safe for a long time ).
Interactions can vary from person to person because of changes in the absorption, distribution, metabolism, gut microbes and excretion of the drug within the body. Because of this, drug reactions largely are unpredictable, even with known interactions.
There are hundreds of possible interactions between commonly prescribed medicines that very few people seem to have heard of. People routinely use these medicines, without much thought because, well, they are medicines and are suppose to cure their ailments! Not enhance them. But unfortunately sometimes they do just the second one as a result of drug interactions! So why do they happen, and why do they matter?
The drug interactions happen mostly because of competition!
Some drugs work in complementary or opposite ways at the same sites in the body. If they're given together, they can compete with each other, reducing (or sometimes increasing) the effect of one or both. A good example is the beta-blocker, which is given to people who've had a heart attack or heart failure, or sometimes high blood pressure. If you have asthma, one of the main treatments is an inhaler called a beta agonist (commonly called Ventolin or salbutamol). A beta agonist makes the beta receptors in your body work better - a beta-blocker stops them. If you have asthma, some beta-blockers can bring on an asthma attack or stop your inhaler from working.
Most medicines you take as tablets get into your bloodstream. After a few hours, they're removed through your kidneys or your liver, which act as filters not just for medicines but for all sorts to toxins and products your body makes. Your kidneys and liver are incredibly complicated organs, with hundreds of different chemicals called enzymes working all the time to stop toxins from building up in your body. If two medicines are broken down by the same enzymes, they can interact. That means that, for instance, if you're taking a statin tablet called simvastatin, you shouldn't also take antibiotics like erythromycin or heart tablets called diltiazem, verapamil and amiodarone. Bizarrely, even drinking grapefruit juice can affect how simvastatin is broken down, so taking the two together can lead to dangerously high levels of simvastatin in your system.
Another danger is, if the side effects are similar, they can add up. For example, if you take allopurinol (Lopurin or Zyloprim) for gout and add the drug azathioprine (Imuran) to treat rheumatoid arthritis, the azathioprine can further suppress your immune system, possibly putting you at risk of a serious infection. And, both aspirin and the blood-thinning drug warfarin (Coumadin) decrease your blood's ability to clot, so if you're taking warfarin for cardiovascular disease and aspirin to ease your migraine problem, you could be unknowingly going for a life-threatening bleeding episode!
Sildenafil (viagra) and Nitrate (sorbitrate) tend to cross-react and can create hypotension (BP fall) they are pharmacologically contraindicated as combination.
And - this is very important - many herbal products and medicines from your alternate medicine kits can interact with other medicines. These include 'natural' remedies for depression.
Moreover if you take alcohol or some vitamin and food supplements, they too might interfere with the medicines' potency and sometimes can cause severe toxic effects and even death!
Alcohol often has harmful interactions with prescription medications, over-the-counter drugs, and even some herbal remedies. Alcohol interactions with medications may cause problems such as:
nausea and vomiting, headaches, drowsiness, dizziness, fainting, changes in blood pressure, abnormal behavior, loss of coordination and accidents.
Mixing alcohol and medications also may increase the risk of complications such as:
liver damage, heart problems, internal bleeding, impaired breathing and depression.
In some cases, alcohol interactions may decrease the effectiveness of medications or render them useless. In other cases, alcohol interactions may make drugs harmful or even toxic to the body.
Even in small amounts, alcohol also may intensify medication side effects such as sleepiness, drowsiness, and light-headedness, which may interfere with your concentration and ability to operate machinery or drive a vehicle, and lead to serious or even fatal accidents.
Hundreds of commonly used prescription and over-the-counter drugs may adversely interact with alcohol. These include medications used for: Allergies, colds, and flu, angina and coronary heart disease, anxiety and epilepsy, arthritis, blood clots, cough, depression, diabetes, enlarged prostate, heartburn and indigestion, high blood pressure, high cholesterol, infections, muscle pain, nausea and motion sickness, pain, fever, and inflammation, seizures, severe pain from injury, post-surgical care, oral surgery, migraine and sleep problems.
Alcohol is metabolized in the liver, and a lot of drugs are metabolized via the same pathways. So it has the potential to interact with a whole host of drugs, including things you might not think are related at all.
One should never drink while on antibiotic treatment.
Certain dietary supplements can change absorption, metabolism, or excretion of a medication and therefore affect its potency. You may be getting either too much or too little of a medication you need if you take these supplements. Dietary supplements are widely used by people and include vitamins, minerals, and other less familiar substances—such as herbals, botanicals, amino acids, and enzymes. Children are more vulnerable in case of drug and supplement interactions.
Natural does not always mean safe. For example, many weight loss products claim to be “all-natural” or “herbal,” but their ingredients may interact with medications or may be dangerous for people with certain medical conditions.
My mother used to take several ayurved medicines prescribed by well qualified ayurved doctors for her knee problems. Some 15 years back she developed severe diabetes with her blood sugar levels going up to 500 - 600 mg/dL. The main stream doctors when consulted asked us about the medicines she was taking. When told about the ayurvedic medicines, they asked us to immediately stop using them. They told us some of them contain steroids that enhance the diabetic conditions several fold if people are vulnerable and genetically predisposed to them.
Warfarin (a prescription blood thinner), ginkgo biloba (a herbal supplement), aspirin and vitamin E (a supplement) can each thin the blood. Taking any of these products together may increase the potential for internal bleeding or stroke.
Antibiotics can limit body's ability to uptake analgesics: Disruption of the microbiota, whether induced by dietary changes, antibiotic administration or invasive pathogens, can disturb the balance of the microbiota and alter metabolic networks. These disturbances can affect the biodisposition of certain drugs, which can ultimately lead to adverse drug reactions (2). There are many diverse mechanisms the gut microbiome can use to alter the disposition, efficacy and toxicity of drugs and foreign substances. These can include the expression of enzymes that can activate or inactivate drugs, the direct binding of drugs to a bacterial organism, the reactivation of drugs by microbial expressed enzymes, and the direct competition between the host and microbes for host metabolizing enzymes. For example, an association between pre-dose, gut-derived urinary metabolites and response to the commonly used analgesic acetaminophen has been reported. Research results suggest that exposure to amoxicillin or ampicillin/neomycin can alter the pharmacokinetics and metabolism of acetaminophen, and that these alterations could be due to changes in gut microbiome composition. Shifts in the composition of gut microbiota can disturb the balance of organisms, which can influence the biodisposition of orally administered drugs (3).
Grapefruit juice can be part of a healthful diet—most of the time. It has vitamin C and potassium—substances your body needs to work properly. But it isn’t good for you when it affects the way your medicines work. Grapefruit juice and fresh grapefruit can interfere with the action of some prescription drugs, as well as a few non-prescription drugs. This interaction can be dangerous. With most drugs that interact with grapefruit juice, the juice increases the absorption of the drug into the bloodstream. When there is a higher concentration of a drug, you tend to have more adverse events. For example, if you drink a lot of grapefruit juice while taking certain statin drugs to lower cholesterol, too much of the drug may stay in your body, increasing your risk for liver damage and muscle breakdown that can lead to kidney failure. Drinking grapefruit juice several hours before or several hours after you take your medicine may still be dangerous. So it’s best to avoid or limit consuming grapefruit juice or fresh grapefruit when taking certain drugs. While scientists have known for several decades that grapefruit juice can cause a potentially toxic level of certain drugs in the body, more recent studies have found that the juice has the opposite effect on a few other drugs.
Examples of some types of drugs that grapefruit juice can interact with are:
some statin drugs to lower cholesterol, such as Zocor (simvastatin), Lipitor (atorvastatin) and Pravachol (pravastatin)
some blood pressure-lowering drugs, such as Nifediac and Afeditab (both nifedipine)
some organ transplant rejection drugs, such as Sandimmune and Neoral (both cyclosporine)
some anti-anxiety drugs, such as BuSpar (buspirone)
some anti-arrhythmia drugs, such as Cordarone and Nexterone (both amiodarone)
some antihistamines, such as Allegra (fexofenadine)
Grapefruit juice does not affect all the drugs in the categories above. Ask your health care professional to find out if your specific drug is affected.
The opposite effect grape fruit juice can have on drugs is important too. It involves the transportation of drugs within the body rather than their metabolism, according to doctors. Proteins in the body known as drug transporters help move a drug into cells for absorption. Substances in grapefruit juice block the action of a specific group of transporters. As a result, less of the drug is absorbed and it may be ineffective.
(Don't confuse grape fruit with grapes - some people who read this article have asked me whether they have to stop eating grapes while taking medicines. The grapefruit is a subtropical citrus tree known for its sour to semi-sweet fruit. Grapefruit is a hybrid originating in Barbados as an accidental cross between two introduced species, sweet orange. I am adding pictures of grape fruit and grapes to help you distinguish between the two types of fruits.
Grape fruit
Grapes
So what can you do now after learning about these things? Discuss with doctors! Stick to one doctor, if possible, who knows your complete health profile and the medicines you are taking..
When you're getting a new medicine from your doctors, tell them about all the medicines you're using. Don't fail to recall and let them know about medicine changes from hospital clinics, dentists etc. And don't forget to mention medicines you get without prescription - even paracetamol or aspirin. That way, your healthcare professional can assess the situation properly and reassure you that they're safe to take together.
Many medicines now come with a patient information leaflet, which should tell you about and other medicines yours might interact with.
Adjust the timing. Some medications interfere with others by keeping the second one from being absorbed in the intestine. For example, antacids can interfere with the body's absorption of tetracycline and some other antibiotics. In those cases, just adjusting the timing a bit will alleviate the problem.
Change the dose – or the drug. Sometimes two drugs interact to increase or decrease the effectiveness of the other. Nonsteroidal anti-inflammatory drugs, for example, can blunt the effects of drugs that treat high blood pressure, sometimes making it necessary to increase the dose of the blood pressure medication. If a drug increases the effect of another, lowering the dose of one may help. In other cases, your doctor can switch you to a different drug that provides the benefits without the interaction risk (4).
Monitor closely. In some cases you need all the drugs you are taking, even if they have the potential to interact. When that happens, your doctor will need to monitor you closely, usually through frequent blood tests. Unless a problem is detected, the risk of taking you off a medication – or perhaps even changing the dose – may be worse than the risk of interactions in such situations.
Although this is usually the choice of last resort, doctors must sometimes prescribe a third medication to help alleviate the problems that an interaction between two other drugs is causing! For example, if you need both NSAIDs (non-steroidal anti-inflammatory drugs, also known as NAIDs, non-steroidal anti-inflammatory agents/analgesics) and corticosteroids, yet taking them together causes stomach upset or increases your risk of developing a stomach ulcer, your doctor may prescribe a third drug to ease your stomach upset and reduce your ulcer risk.
The best thing to do is ... please don't take medicines unless they are absolutely necessary and unless your doctor stresses the need to take them. I don't too! And strictly stick to your doctor's advice. Don't tread the path of misadventures by following what your friends, neighbours and relatives suggest if they are not qualified to give you guidance on health issues.
One more thing: gut microbes may contribute to the dramatic variability that is observed in side effects and efficacy between different patients (1). So what we see in labs is not seen inside human bodies making things very complicated.
Watch this video that confirms exactly what I said above:
References:
1. https://medicalxpress.com/news/2019-06-gut-microbes-medication.html...
2. https://medicalxpress.com/news/2020-03-antibiotics-limit-body-abili...
3. Michael A. Malfatti et al. Manipulation of the Gut Microbiome Alters Acetaminophen Biodisposition in Mice, Scientific Reports (2020). DOI: 10.1038/s41598-020-60982-8
4. Leal Rodríguez C, Drug dosage modifications in 24 million in-patient prescriptions covering eight years: A Danish population-wide study of polypharmacy, PLOS Digital Health (2023). DOI: 10.1371/journal.pdig.0000336. journals.plos.org/digitalhealt … journal.pdig.0000336
Latest research on this:
The researchers tested 23 commonly used drugs using this system, allowing them to identify transporters used by each of those drugs. Then, they trained a machine-learning model on that data, as well as data from several drug databases. The model learned to make predictions of which drugs would interact with which transporters, based on similarities between the chemical structures of the drugs.
Using this model, the researchers analyzed a new set of 28 currently used drugs, as well as 1,595 experimental drugs. This screen yielded nearly 2 million predictions of potential drug interactions. Among them was the prediction that doxycycline, an antibiotic, could interact with warfarin, a commonly prescribed blood-thinner. Doxycycline was also predicted to interact with digoxin, which is used to treat heart failure, levetiracetam, an antiseizure medication, and tacrolimus, an immunosuppressant.
To test those predictions, the researchers looked at data from about 50 patients who had been taking one of those three drugs when they were prescribed doxycycline. This data, which came from a patient database at Massachusetts General Hospital and Brigham and Women's Hospital, showed that when doxycycline was given to patients already taking warfarin, the level of warfarin in the patients' bloodstream went up, then went back down again after they stopped taking doxycycline.
That data also confirmed the model's predictions that the absorption of doxycycline is affected by digoxin, levetiracetam, and tacrolimus. Only one of those drugs, tacrolimus, had been previously suspected to interact with doxycycline.
In addition to identifying potential interactions between drugs that are already in use, this approach could also be applied to drugs now in development. Using this technology, drug developers could tune the formulation of new drug molecules to prevent interactions with other drugs or improve their absorbability.
Screening oral drugs for their interactions with the intestinal transportome via porcine tissue explants and machine learning, Nature Biomedical Engineering (2024). DOI: 10.1038/s41551-023-01128-9
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Study reveals five medication 'prescribing cascades' that may put older adults at risk
"Prescribing cascades" occur when one medication is used to treat or prevent a side effect of another medication. An unintentional cascade can arise when a patient's symptoms are mistaken for a new illness. In that case, the patient not only experiences the original side effect but also faces added risks from the second medication.
Researchers analyzed Irish national prescription data for 533,464 community-dwelling Irish adults aged 65 years and older, covering prescriptions dispensed from 2017 to 2020. The findings are published in The Annals of Family Medicine journal.
A prescription sequence symmetry analysis was performed within a 365-day window to examine nine expert-defined prescribing cascades known as "ThinkCascades." Researchers examined dispensed prescription data only for potential prescribing cascades.
Out of the nine prescribing cascades examined, five had significant positive adjusted sequence ratios, indicating that the patient was more likely to receive the first medication before the second medication:
- Calcium channel blocker leading to diuretic prescribing
- Alpha-1-receptor blocker leading to vestibular sedative prescribing
- Selective serotonin reuptake inhibitor (SSRI) or selective norepinephrine reuptake inhibitor (SNRI) leading to sleep agent prescribing
- Benzodiazepine leading to antipsychotic prescribing
- Antipsychotic leading to anti-Parkinsonian agent prescribing
Three other drug pairs showed significant negative associations, indicating that the patient was less likely to receive the first medication before the second medication:
- Diuretic to overactive bladder medication
- Benzodiazepine to antidementia agent
- Nonsteroidal anti-inflmmatory drugs (NSAIDs) to antihypertensive medication
For clinicians, including adverse drug reactions among the possible causes to confirm or exclude when patients present with new symptoms in primary care is an important step in identifying and mitigating medication-related harm.
Ann Sinéad Doherty et al, Prescribing Cascades Among Older Community-Dwelling Adults: Application of Prescription Sequence Symmetry Analysis to a National Database in Ireland, The Annals of Family Medicine (2025). DOI: 10.1370/afm.240383
Several other articles on this topic are posted in the comments section below.
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Permalink Reply by Dr. Krishna Kumari Challa on
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Pharmacogenomics: How your genes could help doctors choose the right medicine and dose
Pharmacogenomics uses inherited variants to guide drug selection or dosing when evidence supports specific drug–gene actions. Testing can reduce clinically relevant adverse reactions and is used for selected medicines, but genes are only one determinant of response. Wider implementation requires reliable testing, integrated guidance, and clinician training.Two people can take the same dose of the same medicine and have very different results. One may improve, while the other gets little benefit or develops serious side effects. Part of the explanation often lies in their genes.
Pharmacogenomics uses genetic information to predict how someone may respond to certain medicines. Some genes make proteins that help the body process medicines. Others influence how medicines act. Variants in these genes can change how well a treatment works or the risk of side effects.
Genes are only part of the picture. Age, kidney and liver function, other medicines and the condition being treated can all affect a person's response. Allergic reactions also have different causes.
Almost everyone carries a relevant variant. An analysis of nearly 500,000 UK Biobank participants found that 99.5% were predicted to have an unusual response to at least one drug because of variants in 14 well-studied genes. Almost one-quarter had already been prescribed a medicine affected by one of those genes.
The immediate value of this information is narrower than that figure might suggest. A variant becomes useful when someone is taking, or may be prescribed, a relevant medicine and there is good evidence about what a doctor should do differently.
In those circumstances, testing may prevent harmful reactions or ineffective treatment. Genetic differences account for only a proportion of adverse drug reactions, which can range from nausea to life-threatening bleeding. A 2022 study of one month of adult medical admissions at an NHS trust in Liverpool found that an adverse reaction caused or contributed to 16.5% of admissions.
The researchers estimated that such admissions could cost NHS England £2.21 billion a year. This was extrapolated from one NHS trust over a single month, so it is an estimate rather than a national count.
Older people taking several medicines face a particularly high risk of adverse reactions. As the population ages, reducing avoidable harm will become increasingly important.
There is evidence that testing can make prescribing safer. A trial involving 6,944 patients in seven European countries tested variants in 12 genes and gave prescribers drug-specific advice.
Among patients with a result that could affect their treatment, clinically relevant adverse reactions occurred within 12 weeks in 21% of those whose care was guided by the test, compared with 27.7% of those receiving standard care.
Testing is already used for selected medicines. An NHS resource updated in 2025 lists five drug-gene pairs for which testing occurs relatively routinely in England. These include testing the DPYD gene before certain chemotherapy drugs because some variants reduce the body's ability to break them down. Clinicians also test the immune-system gene HLA-B before prescribing the HIV medicine abacavir because one variant increases the risk of a serious hypersensitivity reaction.
Wider use is being explored through an NHS England-funded study examining how a national pharmacogenomic testing service could work. The project is also investigating how results and prescribing advice could be incorporated into clinical computer systems.
The Netherlands offers a useful comparison. Advice from the Dutch Pharmacogenetics Working Group is incorporated into the national medicines database used by prescribers and pharmacists. This makes guidance available at the point of care when a patient's genetic result is known. Access to testing remains a separate issue.
How could a genetic test change treatment?
Consider someone leaving hospital after a heart attack. They may be prescribed clopidogrel to prevent blood clots, a statin to lower cholesterol and omeprazole to protect their stomach.
Some people have CYP2C19 variants that reduce their ability to activate clopidogrel. In certain heart conditions, clinical guidance recommends considering another antiplatelet medicine for people with particular results.
Other variants can influence the risk of muscle symptoms from some statins. CYP2C19 also affects levels of omeprazole, which in turn affects how useful it is in preventing stomach problems caused by other medicines.
Each medicine would still require a separate clinical assessment. A result could give the prescriber additional evidence when choosing a drug or dose.
The same caution applies to antidepressants. CYP2D6 and CYP2C19 variants can influence levels of some antidepressants, and guidelines explain how results may inform prescribing. A result may help a clinician choose a starting dose or consider an alternative. Genes explain only part of someone's response to treatment.
A sample for testing can come from blood or a cheek swab. Because inherited variants do not change, the result could be stored in a medical record for a patient's lifetime and consulted when other medicines are prescribed. Its interpretation may develop as evidence and clinical guidance are updated.
Who could benefit?
People taking several medicines have more opportunities to encounter a relevant drug-gene combination. Fair access will need careful planning, however, to ensure that testing is available to those who need it most.
Pharmacogenomics can reduce some of the trial and error involved in prescribing when a drug-gene relationship is backed by strong evidence. The NHS already has parts of the system in place. Wider use will require reliable testing and current clinical guidance. Prescribers will also need suitable training.
For both clinicians and patients, the practical question is not so much whether we can or should test, but how we can make testing routine.
This article is republished from THE CONVERSATION under a Creative Commons license. Read the original article.
Author: Rebecca Moore
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Overprescribing can take a toll on older people's health and independence—here's what can be done
Around 8 million people in the U.K. take five or more medications each day (known as polypharmacy), with a further 2 million people taking 10 or more prescription drugs daily. Most people who take multiple medications each day are older than 65.
Taking multiple prescription drugs is not necessarily a problem. But it can become problematic when a medicine is overprescribed. This means someone is taking a drug that is no longer appropriate for their circumstances, does not deliver the intended benefit, conflicts with their wishes or could be replaced by a better non-medication option.
In some cases, the consequences of overprescribing can be serious. It may leave people feeling tired, dizzy, confused or unsteady. This can make everyday activities harder and increase the risk of falls, loss of independence and hospital admission. For older adults living with frailty or dementia, these effects can be particularly harmful.
This overlap of medications becomes especially dangerous as we age because our bodies process these drugs differently than they do when we're younger.
For older adults, the kidneys and liver may not remove medicines from the body as effectively as they once did. This means medicines can build up in the body, increasing the risk of side effects and problems caused by taking several medicines together. Medicines that once caused few problems can begin to affect balance, concentration, appetite and energy levels.
One of the biggest challenges with polypharmacy is that drug side effects can look a lot like aging. Feeling tired, forgetful, dizzy or unsteady is often put down to getting older or to dementia itself. But medicines can sometimes contribute to these problems.
This is especially important for people living with dementia, who often take medicines for several other health conditions. For families, it can be hard to know whether changes in memory, mood or behavior are caused by dementia progressing or by the medicines being taken.
The impact of overprescribing and polypharmacy also goes far beyond physical side effects.
In research I conducted with colleagues, people living with dementia and family caregivers described how managing medicines had become part of daily life. Ordering prescriptions, organizing tablets, remembering doses and watching for side effects required constant attention. Many caregivers felt responsible for spotting problems, attending appointments and supporting treatment decisions—yet this often went unrecognized.
Caregivers also described the challenge of knowing whether changes in memory, mood or behavior were caused by dementia itself or by medicines. Many spoke about balancing safety with independence, helping their loved one while preserving as much autonomy as possible.
These experiences were also captured in a short film we produced with family caregivers and people living with dementia.
Our film highlights how medication burden can affect daily life, independence and well-being. It also emphasizes the importance of involving people with dementia and their caregivers in decisions about prescriptions, and asking what matters most to them and whether every prescription drug is still needed.
This does not mean people should stop taking medicines without speaking to their doctor first. Many prescription drugs remain essential and lifesaving. But medicines prescribed years ago are not always reviewed as people's health, priorities and circumstances change over time.
Medication reviews
As we live longer, helping people live well is becoming just as important as helping them live longer. For older adults living with frailty, dementia or several long-term conditions, the focus is not simply on adding more treatments, but on supporting independence, well-being and what matters most to them.
Connecting people with community activities, practical support and meaningful social connections can sometimes be the solution to polypharmacy and overprescribing. After all, better health does not always come from another prescription. Sometimes, staying active, feeling connected and getting the right support can make more difference than adding another pill.
My research has also found that it's possible to reduce the number of medications taken by older people safely without increasing the risk of hospitalization or death. This was true even for those living with frailty or dementia.
If you or someone you care for is taking a large number of prescription drugs, it's worth starting a conversation with your doctor and asking for a medication review. This can help identify which prescription drugs remain important, which may no longer be needed and whether non-medication approaches such as exercise, social activities, practical support or other forms of social prescribing could be helpful.
Medication reviews can help ensure that every prescription drug a person takes is still needed and doing more good than harm. By reducing unnecessary medicines, people may experience fewer side effects, a simpler daily routine and an improved quality of life.
My research found that medication reviews give people and their caregivers an opportunity to ask questions, discuss what matters most to them and better understand what each medicine is for. This can help people feel listened to and more involved in decisions about their care.
This article is republished from THE CONVERSATION under a Creative Commons license. Read the original article.
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Things you need to know about deprescribing
Taking many medications increases the risk of harmful interactions, especially in older adults. Regular reviews can identify medicines that are no longer beneficial or whose risks outweigh their benefits, including some sleep, heartburn and pain medicines. Deprescribing should be agreed on with a clinician, usually tapered gradually and monitored for returning symptoms.
When was the last time your doctor or pharmacist suggested that you consider stopping a medication?
It doesn't happen often enough!
Deprescribing is a growing practice that involves regularly reviewing the medications you're taking and carefully tapering off those deemed redundant or no longer beneficial.
Research shows that up to one in four older adults were taking 10 or more different classes of medication in 2021, even though this type of "polypharmacy" is known to increase the risk of harmful drug interactions eightfold compared with taking two prescribed medications.We know that as we age, drug effects and drug tolerance can change, yet we're very slow to take people off medications. That's what we call clinical inertia. Then when people have safety issues like falling or confusion, they blame it on aging, but it's really the medication.
We can do a better job of helping people age safely by only using medicines when there's really no other option.
And it's not only seniors who should be concerned. It can happen to children and adults, too, particularly those with chronic conditions.
Aging doesn't have to mean more pills
The term "deprescribing" was coined in 2003, and the research has been gaining momentum ever since.
Successful deprescribing means reducing the total number of medications you take, lowering your doses or substituting medications with fewer risks.It's a really critical reassessment.
Patients just kind of accept that being on a lot of pills is part of aging, but it doesn't have to be.Three classes of medications as the most likely to be overprescribed or cause harmful side effects: sleeping pills, heartburn medications and pain prescriptions.
Sleep medicines are among the top 10 medications given to seniors. They fall into a class of medicines known as "psychotropics" that affect the brain and have been linked to harms including confusion, a higher risk of dementia and an increased risk of falls. These medicines should be used only as a short-term, two-week intervention, yet many people keep taking them for years.
Heartburn medications, or "proton pump inhibitors," suppress stomach acid. This can relieve heartburn symptoms in the short term but can be harmful over a longer period. We need stomach acid to help digest our food, absorb nutrients and kill bacteria in our food.Long-term use can affect your bones because you're not able to absorb enough calcium, and it also increases your risk of pneumonia.
Similarly, opioids and seizure medications like gabapentin should be revisited for long-term neuropathic pain.
These medicines cross into the brain and have a lot of side effects there, such as sedation and confusion. They are commonly used, even though there's not always a lot of benefit.Non-prescription substances can have similar side effects, and they may also interact with your medications. For example, taking a sleeping pill along with an over-the-counter antihistamine, Tylenol PM or alcohol can lead to extreme sedation and injury.
People might be getting these kinds of medications without even realizing what they're taking, so yes, even non-prescription products should be reassessed.Whether you've just been given a new prescription or have been on medications for years, experts recommend asking these five questions:
Why am I taking this medication?
What are the potential benefits and harms of this medication?
Can it affect my memory or cause me to fall?
Can I stop or reduce the dose of this medication at some point?
Who do I follow up with and when?And revisit any new medication within six months.
Deprescribing can succeed only when both the patient and the health care professional agree.It requires clear communication about which medications are working for you, which may be doing more harm than good and what the potential consequences of not taking them might be.
Together, you should build a discontinuation plan with a clear timeline for reducing your dose and reassessing. Research shows that most medications are best tapered slowly over weeks or months, rather than stopped cold turkey.
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