Lifelong Health by Dr. David Lipschitz

If you are older than 50, you likely know at least one person with a pillbox filled with innumerable daily medications.

There are many older adults who require four or more medications to control high blood pressure and two or three to regulate blood sugar and who simultaneously take pain medications, antidepressants and sedatives for sleep.

When someone is juggling two, three or four chronic conditions, it is not surprising that his drug count rises. Unfortunately, this all-too-common situation, known as polypharmacy, can have serious ramifications for your health.

Polypharmacy is defined as taking six or more medications. That includes prescription drugs, over-the-counter medications, herbal remedies and multivitamin preparations. The evidence is compelling that if you take more than six different pills daily, it results in a substantial increase in negative side effects; take 10 or more different pills daily and adverse effects are virtually certain.

The major problem with polypharmacy is "drug interaction," when one medication interferes with another and leads to a problem, which can be life-threatening. Many drug interactions are very well-known. For example, many antibiotics, sedatives and painkillers interact with the blood thinner Coumadin and increase the risk of bleeding.

Also, a patient who takes Viagra and also takes nitrates for chest pain runs a high risk of a serious decline in blood pressure. The risk of negative drug interactions is aggravated by advancing age because declines in liver and kidney functions significantly affect the way drugs are metabolized and excreted.

Patients seeing multiple physicians are much more likely to experience the adverse effects of polypharmacy. With each new physician, there are likely new medications prescribed — sometimes without consideration of pre-existing prescriptions. Once a medication has been prescribed, discontinuation is rare, and many patients stay on unneeded drugs for many years.

Occasionally, confusion between the generic name and trade name of a drug can result in duplicate prescriptions. Recently I saw a patient with severe side effects from simultaneously taking Elavil and amitriptyline, the same drug with different names. Other mistakes include the excessive use of acetaminophen, the generic name for Tylenol.

The painkiller Percocet contains a combination of acetaminophen and hydrocodone. Patients in pain often take Percocet and Tylenol, which can lead to serious liver damage.

As a geriatrician, some of my greatest successes have come from prescribing "drug holidays." A drug holiday is when a patient immediately discontinues or tapers off all medications. Recently I saw an 88-year-old man who was taking more than 30 medications daily. He was confused and hallucinating and had very low blood pressure. He recently had fallen and fractured his clavicle.

All of his problems could be ascribed to adverse effects of his medications. Within a week of a supervised drug holiday, his improvement was truly dramatic. Ultimately, we discovered that most of his medications were no longer necessary and that only two prescriptions and three over-the-counter medications were needed. Today he is a new man.

When managing multiple conditions — and multiple medications — it is vitally important to monitor all drugs continually, including over-the-counter medications, herbal remedies and certain nutritional supplements. Always take a complete list to your physician, whether it is your primary care doctor or it is a consultation by a specialist. If a medication is prescribed, talk to your physician to make sure that the indication is fully understood, and ask whether it will interact with other drugs.

In the fight against polypharmacy, perhaps the greatest ally is closer than you think — your local pharmacist. Find a pharmacist you trust, and buy all your medications from his or her pharmacy. A good pharmacist will help keep track of all your medications and ensure you have no adverse reactions. If possible, seek a pharmacy that uses computer programs to identify every possible side effect.

A recent report published in the Archives of Internal Medicine showed that in patients older than 80, analyses of medications by pharmacists employing appropriate computer programs reduced drug-related admissions to hospitals by 80 percent, reduced the number of hospital visits by 15 percent, and substantially decreased costs.

The message is clear: Be vigilant with every pill that enters your mouth. Keep track of all your medications, and always make sure each drug is necessary and appropriate.

Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at www.DrDavidHealth.com.

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