When was the last time you gathered up all your medication and took it with you to a checkup? If, like most people, you’ve never bothered, you might be missing out on an opportunity to improve your health.
As drug regimens become more complex, regular medication reviews — at least every four to six months, and always after a hospitalization — are more important than ever. For each drug you’re taking, ask your doctor these six questions.
1. Do I really need this drug? This is key to understanding the condition you’re trying to treat and can reveal good candidates for elimination. Those include drugs that are no longer necessary, duplicates of other drugs, drugs that are not indicated and drugs that are ineffective.
2. What should this drug do for me? It’s important to understand the goals of treatment. For example, if it’s a drug for high blood pressure, ask about the target reading you should be aiming for. Also ask your doctor if you’ll need to take a drug indefinitely or if you can eventually work toward reducing the dosage or eliminating it altogether by, say, stepping up lifestyle measures.
3. Will this drug interact with other medication or supplements I take? Combining certain drugs can decrease the effectiveness of one or both of them, while other combinations might increase the risk of side effects. Mixing some drugs can even be life-threatening. One common example is combining the pain reliever ibuprofen (Advil and its generic cousins) with the prescription blood thinner warfarin (Coumadin and its generic equivalents), which increases the risk of excessive bleeding.
Herbal supplements can also interact with medication. For example, black cohosh, commonly used to treat menopausal symptoms, might worsen or increase the likelihood of side effects from antidepressants, blood-pressure drugs, cholesterol-lowering statins and other medication. And St. John’s wort, used for depression, can cause a potentially dangerous change in the potency of some drugs.
4. Could I take a lower dose? Aging can have a significant effect on the way the body handles medication. For example, the percentage of body fat tends to increase with age, while the amount of water in the body decreases. That means that water-soluble drugs might become concentrated in the bloodstream, while fat-soluble ones might stick around longer. Aging also affects how well the liver metabolizes drugs and how well the kidneys excrete them.
For all those reasons, the prescribing maxim for older patients is to “start low and go slow.” Although requirements vary considerably from person to person, for those 65 and older, many drugs can be started at one-third to one-half the usual adult dose. You might also need less medication if you’re smaller or thinner than average.
5. What side effects should I be on the lookout for? Ask your doctor what signs and symptoms might arise and how to respond if you take medication that affects blood clotting or blood sugar. Drugs in those groups accounted for two-thirds of emergency hospitalizations for adverse drug events in older people, according to a study last year in the New England Journal of Medicine.
Some drugs cause such pronounced side effects in older people that they’re largely considered inappropriate for them. These include a broad group of drugs known as anticholinergics, which are used to treat various conditions including allergies, asthma, stomach ulcers and urinary incontinence.
6. Are there nondrug alternatives? For many conditions, including elevated cholesterol, high blood glucose and hypertension, lifestyle changes such as weight loss and exercise can reduce, delay or even eliminate the need for medication. For example, while metformin (Glucophage and its generic cousins) can delay or prevent the onset of Type 2 diabetes in people with borderline high blood sugar, lifestyle steps are more effective and have numerous other benefits, too.