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Bad MedicinesDrugs Older Adults Should Avoid
If you take a medication on this list, make sure to ask your doctor why.
A report in the December 12, 2001, issue of the Journal of the American Medical Association (JAMA) suggests that millions of Americans age 65 and older have taken medications that may cause problems for people their age. The study’s findings highlight the need for you to be informed about the medications you are taking—especially when adding a new prescription to your daily mix.
With help from an expert panel, the researchers composed a list of 33 medications considered to be “potentially inappropriate” for use by seniors due to unacceptable side effects or the availability of safer and more effective alternatives. The experts divided the 33 drugs into three categories:
Always inappropriate
The study determined that in 1996 nearly 3 percent (about 840,000) of older adults living outside of nursing homes might have used one or more drugs that the panel agreed were never appropriate for use by this age group. (See table at right for the details.) A prime example is meperidine (Demerol), a pain reliever that may cause seizures in older people. “There are so many better choices available for the treatment of pain,” says Helen Edelberg, M.D., Assistant Professor, Brookdale Department of Geriatrics and Adult Development, Mount Sinai School of Medicine. “There is no reason to choose Demerol.”
Rarely appropriate:
The generic and trade names of these eight drugs, prescribed to an estimated 9 percent of older adults, are chlordiazepoxide (Librium), diazepam (Diastat), propoxyphene (Darvon), carisoprodol (Sodol), chlorzoxazone (Flexaphen), cyclobenzaprine (Flexeril), metaxalone (Skelaxin), and methocarbamol (Delaxin). A good example of drugs in this list is propoxyphene, a painkiller. It is no more effective than aspirin or acetaminophen (Tylenol), but has a sedative effect and can be addictive. “The only reason you would consider keeping someone on propoxyphene is that they’ve been on it for a long time, they have not experienced any untoward side effects, and they insist that you give it to them,” Dr. Edelberg says.
Appropriate for certain uses
The panel felt these drugs can be prescribed in particular circumstances—for example, when the person doesn’t respond to a better drug—but should still be avoided if possible. Prescribed to 13 percent of older adults in 1996, this list includes amitriptyline (Elavil), doxepin (Adapin), indomethacin (Indocin), dipyridamole (Persantine), ticlopidine (Ticlid), methyldopa (Aldomet), reserpine (Resa), disopyramide (Norpace), oxybutynin (Ditropan), chlorpheniramine (antihistamine/decongestant mixed with other medicines and sold under dozens of brand names), cyproheptadine (Periactin), diphenhydramine (Benadryl), hydroxyzine (Anxanil), and promethazine (Anergan).
How to protect yourself
If you currently take one of the 33 potentially inappropriate medications mentioned in this article, don’t suddenly stop taking it. However, Dr. Edelberg says, you should ask your doctor to explain why you are receiving it and ask if there is an alternative. Also bring all of your prescriptions and dietary supplements to your primary care physician or geriatrician every time you visit. This will allow the doctor to identify potential problems if your prescriptions and dosages change. “It’s not infrequent that I pick up on a problem related to an over-the-counter or prescription medication,” Dr. Edelberg says.
