Medications: How Many is Too Many?
This month we tackle a challenging question about aging. How many medicines are too many for any one person to take? The answer depends on exactly what medicine is indicated for the particular medical problem being treated. Easy answer, but this simple answer is not that simple.
Specific Treatment for a Specific Disease
Perhaps counter-intuitively, there often are a number of "right" specific treatments for a person’s particular problem or disease. This is for your physician and you to figure out. And once the correct drug for you is selected, the right dosage for you discovered, then you are all set. Or are you? What if you have more than one disease?
As We Age We Have Multiple Problems
Developing any number of medical problems and or diseases that are acute or chronic is a normal part of aging. Each disease or problem may have a specific medicine(s) appropriately required to treat or control it. This is how, as we all age, we tend to accumulate more than one daily medication. It has been reported that over a third of women and men between 75 and 85 years of age took at least five prescription medications. As each medicine is added the risk is increased regarding its effectiveness or appropriateness, and you and your physician and/or pharmacist need to be acutely aware of the problem of many medications.
Polypharmacy & Aging
Polypharmacy is the term used to describe multiple medications for a patient and sometimes it is used to convey the use of unnecessary medications. However, I would like to keep the term simple and define polypharmacy as the use of multiple medicines in one person. This brings us to the question and title of the column – “How many medications is too many?” The question can be further refined – does aging affect the answer to how many is too many?
The process of aging does directly affect the number of medicines, since as already mentioned we tend to have more medical problems that require medicines for treatment. But, as we age things do change in our bodies that can alter medicine actions. We can have changes as we age in the way we metabolize medicines and we can have altered sensitivity to the medicines (meaning they can be more or less effective than in young people).
An example of changed metabolism is that some drugs are excreted by our kidneys, but as we age our kidneys tend to clear these drugs less efficiently, meaning that the dose needs to be reduced to avoid toxicity. An example of increased sensitivity as we age is the effect that some classes of drugs have at their receptors. The same dose in a young person can have a significantly greater effect in the older person and the drug then needs to be lowered for the older patient.
Common Problems of Polypharmacy in Older Patients
The most common problems encountered with multiple prescriptions in the elderly are listed in the section below. Some seem contradictory, for example, overdose and overdose, but as explained above this happens depending on how each person responds to a particular medicine and/or the interactions of one medicine with another.
Some drugs will interact with others. This is particularly true with sedatives and some of the anticoagulants. Any time a new medicine is added you have to look for any lack of effectiveness in the old one. Of course, this is done with the advice of your doctor.
Many of the medicines that one can buy and self-prescribe can affect the prescription drugs we are taking. For example, over-the-counter cold remedies and decongestants can interfere with medicine prescribed for sleep.
Diet certainly has an effect on medications, probably the most prominent is Coumadin interaction with green vegetables, that make the Coumadin less effective. However, there are many other dietary interactions that you and your doctor should discuss about every medicine you are on.
One of the most common problems as we age is confusion about the many medicines we are taking. We can forget to take them or mix them up (take the wrong one at the wrong time). The remedy for this is to keep all medicine in one place and have a sheet of paper that tells what, how much, and when to take the medicine and then check it off each day.
Common Problems of Multiple Drugs in Older Patients
- Overdose: The medicine acts unexpectedly stronger in patient
- Underdose: The medicine acts unexpectedly weaker in patient
- Drug - Drug Interaction: Drugs acting together can cause over or underdose
- Over-the-Counter Medicines: Over-the-counter medicines can cause drug - drug interactions
- Diet: Some medicines are positively or negatively affected by diet
- Failure to Take as Directed: Medicine must be taken as directed and not omitted
The Bottom Line
As we age almost certainly we will begin to have multiple medicines we take daily. It is our responsibility to carefully watch the effect that each new medicine has: both with respect to the old ones and is it doing what it is supposed to without undesirable side effects? Every time one goes to the doctor review all medicines including over-the-counter medications and any dietary changes to minimize the problems of polypharmacy.