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RECENT SENIOR HEALTH STORIES

 
April 2, 2001
SENIOR HEALTH
Med Alert: Seniors Should Use Caution with Many Medications
By Jonathan Freedhoff, M.D.

illustration: Skipper Chong Warson

Every day we grow a little older: Our hair gets a little grayer, our waist gets a little wider, and gravity wages its perpetual war on us. Unfortunately, our appearance is not the only thing that changes -- inside the body, our muscle mass decreases, our brain shrinks, and our liver and kidneys begin to function less efficiently. By the time we reach our senior years -- after the age of 65 -- our body has changed. Wounds take more time to heal, our muscles need more time to warm up, and medications may not be metabolized correctly. In fact, the same medications that are instrumental in managing illnesses earlier in life can do more harm than good to the health of a senior.

Each year in America there are more than 140,000 hospital admissions due to adverse drug reactions; not surprisingly, many of these reactions occur among seniors. If elderly patients received information on what kinds of drugs affect them adversely, the frequency of these unnecessary admissions could be reduced.

Why age matters

In order to metabolize and utilize medications, the body relies primarily on the liver and the kidneys. If these organs are not working at full capacity, which happens frequently in the elder years, certain drugs may be less effective, while others can build up to toxic levels. In addition, due to changes in body fat and muscle mass as we age, drug distribution in and around the body is also affected. Because of a lack of effective metabolization, medication that was once distributed evenly throughout our system may become concentrated, sometimes even to dangerous levels.

In North America, seniors account for 25 percent of all prescription drug sales. While not every medication is dangerous to the senior population, recent studies suggest that as many as 40 percent of seniors take at least one prescription that is not appropriate for them. Often when elderly patients experience an adverse reaction, they chalk it up to aging, not realizing that the problem may lie with the medication itself. For physicians treating older patients with decreased cognitive abilities, diagnosing adverse drug reactions can be difficult. Consequently, patients and physicians alike often overlook common drug-reaction problems.

While not every medication is a risk, some are far more likely than others to cause dangerous side effects in seniors. Those drugs that could pose a risk for seniors are listed below along with potential reactions. Keep in mind that the list is by no means complete and that every medication has the potential to cause an adverse reaction. However, if you are over the age of 65 and are taking any of the medications listed below, be sure to discuss potential risks with your physician.

Commonly Prescribed Medications That May Cause Problems in Seniors

Medication

Purpose

Risks

Indomethacin (Indocin)

Anti-inflammatory

More likely to cause confusion and memory disturbances than other anti-inflammatory medications

Pentazocine (Talwin)

Narcotic analgesic

More likely to cause confusion and hallucinations than other narcotics

Methocarbamol (Robaxin)

Muscle relaxant

Highly sedating and may cause dry mouth, nausea, urinary retention, dizziness, palpitations, and weakness

Oxybutynin chloride (Ditropan)

Antispasmodic

Highly sedating and may cause dry mouth, nausea, urinary retention, dizziness, palpitations, and weakness

Cyclobenzaprine (Flexeril)

Muscle relaxant

Highly sedating and may cause dry mouth, nausea, urinary retention, dizziness, palpitations, and weakness

Flurazepam hydrochloride (Dalmane)

Sedative

Has an extremely long half-life in the elderly, causing increased fatigue; has been shown to increase the risk of falls and fractures

Doxepin hydrochloride (Sinequan)

Antidepressant

Highly sedating as compared with other antidepressants

Amitriptyline hydrochloride (Elavil)

Antidepressant

Highly sedating as compared with other antidepressants

Methyldopa (Aldomet)

Antihypertensive

Can cause dangerously slow heart rate and may exacerbate depression

Chlordiazepoxide (Librax/Librium)

Tranquilizer

Has a very long half-life, causing increased fatigue, and has been shown to increase the risk of falls and fractures

Diphenhydremine hydrochloride (Benadryl)

Antihistamine

Highly sedating and may cause dry mouth, nausea, urinary retention, dizziness, palpitations, and weakness

Hydroxyzine (Atarax)

Antihistamine

Highly sedating and may cause dry mouth, nausea, urinary retention, dizziness, palpitations, and weakness

Donnatal (Belladonna)

Anticholinergic, Antispasmodic

Highly sedating and may cause dry mouth, nausea, urinary retention, dizziness, palpitations, and weakness

Be drug savvy

Even if you are not a senior on any of the above medications, you should make it a point to be drug savvy. As part of your annual physical examination, ask your physician to review all of your medications and their dosages. Remember that the more medications you are taking, the higher your risk of side effects and dangerous drug interactions. This warning includes herbal medications since most have not been studied to determine their interactions with conventional medications.

By reviewing your medications with your physician, you will know exactly what you are taking and why, and your physician will have an opportunity to assess your needs. Lastly, always remember to carry a list of your medications with you in case of an emergency.

In the senior years, and at any time, educating yourself about the medications you take can help you better control your illnesses and can preserve your health for years to come.

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