Talk to Your Doctor About Stopping These 9 Medicines
Doctors call it polypharmacy. When patients take too many medications, there is a concern that there are chemical combinations inside the body to cause problems that we cannot predict. It is akin to an unknown chemistry experiment and it is anyone’s guess as to what the result will be.
When you take one prescription, we can easily tell you what side effects might occur. When you take five or more medicines, we can only guess, and the guessing is hard.
When I was in medical school, I was taught that a patient taking more than five prescriptions was at risk for polypharmacy. More than 9 medicines was putting someone at risk of death within the next 12 months. This is especially true in patients over the age of 65, when side effects such as dizziness, breathing problems, a sudden drop in blood pressure, or falls, become a serious risk.
When I first graduated from residency, I worked in the emergency room when I wasn’t away on mission trips in Haiti.
It did not take long to notice that many of the patients I saw in the ER were taking a laundry list of medications.
Including some young adults. While many of these medicines may have been necessary to treat their illnesses, drugs were also putting them at risk for serious side effects. Many drugs they were on were used to treat the side effects of other drugs. It was a snowball effect of medicine with seemingly no end in sight. If only we could backtrack and work on treating the root cause of the original disease instead of piling on all of these pills. (That was when I got serious about Integrative Medicine, but I digress…)
One survey completed in 2017 found that more than 50% of female Medicare beneficiaries took five or more medications daily. The survey also showed that 12% of women with Medicare were taking 10 or more medications daily, putting them at risk for death within the next year. This translates into 62% of women on Medicare at risk for polypharmacy. This concerns me.
Seeing these patients who were on so many medicines for illnesses that could be reversed or prevented through changes in lifestyle was but one reason I was driven to continue my education in integrative medicine. These patients continue to motivate me to help people heal themselves naturally, so they do not have to face a lifetime of dozens of prescriptions and ongoing illness. However, that is not the point of this post.
While no one should ever stop taking a medication without consulting their personal physician, there are several medications I frequently see prescribed that have been found to have little health benefit. For some reason, these medications continue to be prescribed or recommended even though they are rarely, if ever, helpful.
I do not want to make any enemies with my physician colleagues. However, my goal is to help my readers obtain the best health possible. The unfortunate reality is that although research has shown for years that these medicines are not beneficial, many patients are still taking them. First, do no harm is always my goal.
There are exceptions to the following list. You may need one of these medicines for a different reason than the standard reason it is prescribed. Please do not stop any medicine until speaking to your doctor. If your doctor tells you it is necessary for you, listen to your doctor, not me. I do not know your specific medical history or needs. This information is for educational purposes, only.
Here are drugs you may consider stopping after discussing with your doctor:
Docusate (Colace ®)
This medicine is often prescribed as a stool softener. It is actually just soap. There is no evidence to show that is treats or prevents constipation. While this medicine is very safe and will not cause risk of polypharmacy, using it is literally flushing money down the toilet. A better medicine is Psyllium, which is a type of fiber which is very effective for the treatment and prevention of constipation.
Proton Pump Inhibitors (PPIs)
This is a huge pet peeve of mine. That purple pill is one of the most prescribed medications in the country, and now that it is available over-the-counter, even more, people take it on a regular basis to treat heartburn. This is a dangerous road to walk. What is a PPI? Omeprazole, pantoprazole, and esomeprazole are all PPIs. These medicines are needed in a few patients but are only rarely necessary long-term. They are only meant to be taken for a maximum of 2 months in most patients. Many risks have been associated with long-term use of PPIs, including calcium deficiency, vitamin B12 deficiency, problems with thyroid hormone absorption, kidney disease, osteoporosis, increased risk of fractures, and increased risk of infection with Clostridium difficile (aka C.diff), a terrible intestinal infection which can be difficult to treat. There are also some studies that link long-term PPI use to increased risk of cardiac death, although the jury is still out on the actual risk between PPIs and heart problems. PPIs also disrupt your normal Gut flora and can increase your risk of irritable bowel syndrome, a sign that you suffer from SIBO – small intestinal bacterial overgrowth. Whatever the symptom, please talk to your doctor about how to safely stop your PPI if you have been taking it for more than 2 months. In my professional opinion, these medications should never have been allowed to be made available over-the-counter. The risks are far too high. If you take a PPI for heartburn, note that research studies show that changes in lifestyle are more effective than these drugs. Most notably, following a Mediterranean Diet and drinking alkalinized water decrease reflux symptoms more effectively (and safely) than PPIs.
Antibiotics Before Dental Procedures
As many people know, antibiotic resistance is a real problem, and antibiotics also cause an imbalance in the normal healthy gut microbiome. Taking them unnecessarily is a bad idea. 20 years ago, it was routine to prescribe antibiotics to patients with artificial joints, such as knees and hips, before dental procedures. The Academy of Orthopedic Surgeons and the American Dental Society no longer recommend this practice. Unfortunately, some dentists and physicians are still prescribing routine antibiotics before procedures. Some patients with artificial heart valves may still need antibiotics when heading to the dentist.
(Simvastatin, Atorvastatin, any drug that ends with -statin) – if you have never had a heart attack and you are over the age of 75. There is little to no evidence to show that using a statin drug, even if you have high cholesterol. Statins can be associated with muscle cramps and spasms, can increase the risk of diabetes and can interact with several other drugs which can lead to toxic effects. There is a difference in the benefit if you have had a heart attack or stroke, and then the risk vs. benefit may mean the statin is worth taking if your doctor is recommending the medicine. If you are over 80 years old and on a statin, the risk of taking a statin drug simply for prevention is even more concerning.
Beta-blockers for Blood Pressure
Atenolol, metoprolol, propranolol, and many others – For many years, these blood-pressure-lowering drugs have been prescribed after a heart attack for at least 3 years after the cardiac event. However, more recent research data has shown that there is no long-term benefit in continuing these medicines. We no wonder if there is really a short-term benefit, either. I still recommend these medicines when someone first has a heart condition because they do make people feel better, especially in an emergent situation. Recent studies have found that beta-blockers should not be used alone for long-term treatment of blood pressure, especially the drug atenolol. While atenolol lowers blood pressure quite nicely, recent studies show that it does not decrease the risk of heart attack or stroke, which is the reason we treat blood pressure in the first place. Not only that but all beta-blockers lead to weight gain which increases the risk of heart disease. There are other blood pressure medications that lower the risk of heart attack and stroke without causing weight gain. When beta-blockers are used to control a rapid heart-rate, they are still effective drugs and should not be stopped.
(alprazolam (Xanax), lorazepam (Ativan), diazepam (Valium), zolpidem (Ambien), temazepam (Restoril) – these drugs are addictive when used for more than two weeks, and over time they lose their potency. Some studies have found that when used long-term, some of these medicines can increase the risk of dementia. In the elderly, these medications increase the risk of serious falls. Falls can lead to head injuries and broken bones, the most common being hip fractures which often require surgery. I see this regularly in the emergency room, and if we can prevent it, we should. While insomnia is a common concern in the elderly, there are safer ways to treat sleep problems than these drugs. Most commonly, the insomnia is a result of another medication on the list.
Medicine for Urinary Incontinence
Many people suffer from leaking urine as they grow older. Women often have this problem even in their younger years, especially if they have had a few babies. Research studies show that drugs prescribed to help with urinary incontinence are not helpful for most people who take them. These drugs have many unpleasant side effects, as well. One of the most commonly prescribed medicines for urinary incontinence is the drug oxybutynin. Out of 1000 prescriptions, only 114 patients had their symptoms resolve. While incontinence is an unpleasant problem to have, the medicines used to treat it are also unpleasant, and rarely effective.
Drugs to treat Alzheimer’s Disease
These medicines only have a very small benefit and uncomfortable side effects. Unfortunately, many patients taking them are unable to tell us the way they feel with these medicines which means often, they are continued. The most commonly prescribed medications in this class is donepezil (Aricept®). Unfortunately, only 1 in 12 patients prescribed this medicine will have benefit. So, eleven patients suffer from side effects for every one patient who has a small benefit. Common side effects include nausea, decreased appetite, weight loss, diarrhea, syncope (passing out), and urinary incontinence (loss of ability to hold in urine). Those with these side effects are usually started on other drugs to treat the side effects of Alzheimer’s drugs. These drugs can affect their memory and thinking processes further, such as the drugs commonly used for urinary incontinence and appetite stimulation.
There are a lot of supplements touted as being a cure-all for any number of ailments, and some are recommended by physicians. While this is a big topic for another day, one supplement commonly prescribed that has no proven benefit for the reason it is prescribed is calcium. I have already written about this in another post which can be found here. In short, there is no evidence that prescribing Calcium or calcium +D prevents osteoporosis or fractures in anyone over the age of 30 years old. We do know this supplement decreases absorption of thyroid hormones and certain antibiotics, and that it can increase the risk of kidney stones. Most people get enough calcium in their diet for general health. If you need it for other reasons other than bone health, your doctor can help you find the correct dose.
You are the most important stakeholder in your health
Keep in mind that over-the-counter medicines that are available without a prescription can have dangerous side effects and lead to polypharmacy, too. Commonly misused OTC drugs include cold and cough medicines, medicines used for constipation and diarrhea, allergy and sleep aids, and pain relievers. When taken too often, at the wrong doses, or in combination with prescription drugs, these medicines can be just as deadly as prescription drugs. Some should never be taken by individuals with certain health conditions. Serious side-effects and death can even occur with herbal dietary supplements that may seem safe because they are “all natural.” However, keep in mind that if something is effective in treating a disease or symptom, it will also have the potential to cause a side effect that can be dangerous.
With limited appointment times and complicated lists and doctors who are asked to do more and more, it is important for all of us to pay close attention to our health and wellness needs. Unfortunately, many patients come to the doctor seeking a magic pill that will cure their symptoms, so too often pills are added to lists even though the best treatment is not medicine, but a change in habits. My favorite way to treat many of the issues listed above such as constipation, heartburn, high cholesterol, high blood pressure, and insomnia include changes in lifestyle. All of these are treatable without prescription drugs, but only if patients are willing to take charge of their health. I hope this information will help you work with your doctor to make decisions together to help you stay healthy.
Welcome to your New Chapter in Health!
– Angela Kerchner, M.D.
Board Certified, American Board of Family Medicine
Diplomate, American Board of Integrative Holistic Medicine
Diplomate, American Board of Obesity Medicine
Medscape Family Medicine: 11 Drugs You Should Seriously Consider Deprescribing