Taking Too Many Drugs? Why You Should Discuss If Deprescribing Is for You

The more prescription drugs you take, the higher the risk for adverse reactions. And because you become more sensitive to the side effects of drugs as you age, reviewing your prescriptions is increasingly important, experts say.

National Public Radio recently reported on the perils of too many prescriptions and the movement by some clinicians to suggest that their elderly patients deprescribe, or reduce the dose of medications that might be causing harm or stop them altogether under the guidance of a doctor. 

Adverse Reactions

About one in five adults ages 40 to 79 used at least five prescription drugs in the United States and Canada, according to the U.S. Department of Health and Human Services. And use of five or more prescription drugs was more common among adults ages 60 to 79, compared with those ages 40 to 59.

Because drugs do not act in isolation in your system, they can interact in several ways, including decreased bodily fluid, slowed digestive system function, decreased liver function, decreased kidney function, memory problems, visual and hearing problems and decreased dexterity. Your doctor might attribute these symptoms to a new disease and prescribe another drug, exacerbating the problem.

Of specific concern recently are anticholinergic drugs — a wide-ranging class of medications used to treat allergies, diarrhea, dizziness, insomnia, asthma, leaky bladders, motion sickness, Parkinson’s disease, chronic obstructive pulmonary disease and various psychiatric disorders. The Washington Post reports that an estimated one in four older adults take anticholinergic drugs. Older adults are highly susceptible to negative responses to these medications, including memory loss and cognitive changes. Several studies have even noted an association between anticholinergics and a heightened risk of dementia and increased risk for falling. According to a research review by physicians at the Medical University of South Carolina and in Britain, “physicians often attribute anticholinergic symptoms in elderly people to aging or age-related illness rather than the effect of drugs.”

When to Talk to Your Doctor

If you notice changes in your health, talk to your doctor and ask if drug interactions could be the cause. Reducing medications can sometimes cause drug withdrawal symptoms, and some medicines need to be reduced slowly to avoid withdrawal effects. So make sure you talk to your health care provider(s) before stopping a medication.

You might also consider making an appointment specifically to discuss deprescribing. Barbara Farrell, a pharmacist and clinical scientist who co-leads a project that publishes deprescribing guidelines for the elderly, suggests that you prepare for your doctor appointment by making a list of all drugs you are taking and drawing a column for each drug with each these categories: the reason for taking it, who prescribed it, when you started taking it, whether it’s working and the side effects.

What to Ask Your Doctor

Your doctor will be able to discuss if your prescription is still necessary or if a safer alternative is available. Questions you can ask your doctor about deprescribing include:

• Why am I taking this medicine?
• What are the potential benefits and harmful effects?
• Was this drug initially prescribed for a short time, and is it safe to be taking it long-term?
• Can it cause me to fall?
• Can it affect my memory?

Cost Savings of Deprescribing

In addition to reducing adverse side effects, deprescribing may also lower your costs. Fewer prescriptions mean less money spent at the pharmacy, but it also can reduce your overall health care costs. If your health problems were caused by drug interactions, eliminating the cause can eliminate treatment costs and even prevent costly emergency room visits. Every day, 750 older people living in the United States ages 65 and older are hospitalized due to serious side effects from one or more medications.

While potential cost savings can be a motivator to review your medications, deprescribing is usually done because the drug may be causing harm, may no longer be helping you, or may be inappropriate for your current situation. Remember to always talk to your doctor before discontinuing any medication.