Drug interactions and the elderly

About half of all senior patients take several prescribed or over-the-counter (OTC) drugs simultaneously, and frequently over prolonged periods. Many conditions mistakenly considered new diseases are, in fact, unrecognised drug interactions. Doctors then prescribe yet more drugs to solve the new problems, which only makes matters worse.

If you or your relations are elderly and need to take medication, there are many ways that you may be able to prevent the worst side-effects of drugs.

The greatest overuse of medicine is among the institutionalised elderly. The average nursing home patient receives eight different drugs a day. This may be because the patient has different ailments, but it may also be because he or she has different doctors.

Patients can also suffer drug-withdrawal symptoms when drugs are stopped too abruptly. You can suffer angina pectoris from abruptly stopping beta-blockers, or hypertension when you come off calcium antagonists, or drug-withdrawal symptoms when you stop narcotics or benzodiazepines. In these instances, you need to be weaned off these types of drugs slowly. There are other, extraneous risk factors, like the increased risk of a fractured hip with benzodiazepine use.

The most common cause of side-effects is when doctors inappropriately prescribe a drug to treat unrecognised drug effects. Oftentimes, doctors will dole out tricyclic antidepressants to treat beta-blocker depression, or hand out a potent tranquilliser to treat agitation due to benzodiazepines.

If you or your elderly relative are being prescribed a drug:
* Ensure that a clear diagnosis backed by laboratory tests has been made before a prescription is issued
* Keep a record of the drug history
* Read the package inserts to know the pharmacokinetics (the absorption, distribution, metabolism and excretion in the body) of the drug(s)
* Check the labels placed on the drug(s) by the pharmacist
* Ask to take the lowest possible dose
* Urge the doctor to simplify the drug regimen and insist on regular drug reviews
* Ideally, avoid taking more than one drug whenever possible
* Use medication containers, such as egg cartons, for preparing daily doses
* Instruct the whole family on your regimen
* Return old medicines to the pharmacy
* Consider the possibility of overdose in elderly patients with psychiatric conditions
* Be aware – and be sure that elderly patients are also aware – that medicines can cause, as well as alleviate, illness.

If you are being prescribed two drugs, here are the most common interactions between drugs that are frequently prescribed, and ways to reduce them.

* Angiotensin-converting enzyme (ACE) inhibitors + NSAIDs (non-steroidal anti-inflammatory drugs)
Check blood pressure on day 1 of NSAID administration

* Antacids + iron salts
Take iron (preferably in liquid form) several hours before the antacids

* Benzodiazepines + alcohol
Avoid alcohol

* Beta-blockers + prazosin
Take as far apart as possible and have your standing blood pressure monitored

* Beta-blockers + NSAIDs
Have your blood pressure checked

* Cimetidine + procainamide
Reduce the dosage of procainamide by one-third before starting cimetidine

* Clonidine + tricyclic antidepressants Never take these together

* Digoxin + quinidine
Never take these together

* Digoxin + tetracycline
Never take these together

* Digoxin + anticholinergics
Use liquid or rapidly dissolving digoxin preparations

* Lithium + thiazide
Loop diuretics (such as frusemide/furosemide, bumetanide and torasemide) are preferable to thiazide. A careful reduction of lithium dosage may be indicated

* Salicylates + warfarin
Never take these together

* Theophylline + beta-blockers
Patients with reactive airway diseases should avoid beta-blockers.

Osteopathic manipulative therapy for range of motion, and respiratory and muscle energy and, in particular, craniosacral osteopathy for compression of the neck bones, are invaluable treatments for the elderly (Osteopath Ann, 1979; 7: 115-9).

Homoeopathy has a reliable multisystem remedy for the complaints of advancing years – Acidum sarcolacticum – which I use in a 30CH potency to good effect. Its clinical keynotes, revealed in provings (the homoeopathic equivalent to clinical trials) in healthy subjects, all point to signs of ageing: multiple joint degeneration, general exhaustion, itching, scaly eczema and profuse night-time urination (J Am Inst Homeop, 1966; 159: 3-4).

Harald Gaier

Harald Gaier is a registered homoeopath, naturopath and osteopath.

Sources: Ann Intern Med, 1991; 114: 956-66; Ann Pharmacother, 1989; 23: 847; N Engl J Med, 1991; 324: 1326; Geriatrics, 1989; 44: 57; British National Formulary, March 2000; 39: 16-7.

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Written by What Doctors Don't Tell You

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