More than likely, an individual will take medication at some point in his or her life. As individuals accumulate medical problems, the number of medications they take is likely to increase. Depending upon the medical problems being treated, the total number of prescribed medications and the frequency of administration may vary. For example, for treatment of hypertension, only one blood pressure medication taken once daily may be enough, whereas systolic heart failure may require four or more medications to be taken on a daily basis. Previously, I discussed questions an individual needs to ask to determine if the risk of medications may outweigh the benefits.
In 1997, Dr. James Beers published the work he and his colleagues collaborated on to identify medications they believed likely to cause problems in their older patients. Many of the effects included increased sleepiness, confusion, dangerously low blood sugars and blood pressures, confusion and falls. Often times, substitute medications were available for those identified as “potentially inappropriate;” the substitutes were just as effective in treatment of the individual’s medical condition, but had a safer side-effect profile. This “Beer’s List” of medications has undergone several modifications over the years, and was eventually adapted by the American Geriatrics Society. It is updated on a regular basis; the latest update was released within the last month.
The list includes commonly prescribed medicine: depression and anxiety medications, diabetes medications, pain medications and muscle relaxants, allergy medications and blood pressure medications. Over time, medications have been added to and removed from this list, reflecting changes in the medical literature. As expected, this list will change over time as new medications are developed and published literature documenting their side effects grows.
An individual’s medications should be frequently reviewed with the prescribing physician to confirm they’re still necessary and they’re doing what they are supposed to do. A review also looks at side effects or interactions with any other medications, and potential safer substitutes if available. The Beer’s List is meant to address the last detail — can any current medications be substituted with another, safer option. Safety concerns include the higher potential of side effects experienced by older individuals, and the possibility that these medications may somehow exacerbate or be influenced by the medical problems that an individual has. For instance, certain medications, such as ibuprofen and metformin, should be avoided by individuals with kidney problems. Ibuprofen and naproxen may also lead to an exacerbation of heart failure. Psychiatric medications such as citalopram or risperidone may worsen the motor symptoms of an individual with Parkinson’s disease. Cross referencing certain medications with an individual’s specific medical conditions should be a part of the medication review.
It also benefits the patient to understand why he or she is taking each medication; often, people take these pills without fully knowing their intention. Sometimes, due to changes in an individual’s health, medication that they have been taking for a period of time may no longer be necessary. Regular review with a doctor can help identify these opportunities to cease medication. In the meantime, understanding treatment being taken and its appropriateness is an important aspect of overall health and well-being. While the role of doctors includes educating those receiving their care, I encourage patients to ask questions about the medicine they’re being prescribed. This approach will contribute to constructive and effective medication reviews and utilization.
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Should I Be Taking This Medication? originally appeared on usnews.com
