Tom Ballard, ND's blog


Drug Side Effects in the Elderly
January 6, 2011, 10:09 am
Filed under: Commentary, Medications | Tags: , , ,

The elderly aren’t the only ones being prescribed pharmaceuticals, but they’re more likely to be taking several. Along with children, the elderly are most likely to have adverse reactions to medicines. This is mostly due to their lessened ability to detoxify and remove chemicals from the body.

From: Worstpills.com (Public Citizen)

Each year, more than 9.6 million adverse drug reactions occur in older Americans. The referenced study found that 37% of these adverse reactions were not reported to the doctor, presumably because patients did not realize the reactions were due to the drug. This is not too surprising considering that most doctors admitted they did not explain possible adverse effects to their patients.

The following national estimates are based on well-conducted studies, mainly in the United States:

  • Each year, in hospitals alone, there are 28,000 cases of life-threatening heart toxicity from adverse reactions to digoxin, the most commonly used form of digitalis in older adults. It is estimated that as many as 40% or more of these people are using this drug unnecessarily, even by pro-pharmaceutical researchers. Therefore, many of these injuries are preventable.
  • Each year 41,000 older adults are hospitalized—and 3,300 of these die from ulcers caused by NSAIDs (nonsteroidal anti-inflammatory drugs, usually for treatment of arthritis). Thousands of younger adults are hospitalized due to these drugs.
  • At least 16,000 injuries from auto crashes each year involving older drivers are attributable to the use of psychoactive drugs, specifically benzodiazepines and tricyclic antidepressants. Psychoactive drugs are those that affect the mind or behavior.
  • Each year 32,000 older adults suffer from hip fractures—contributing to more than 1,500 deaths—attributable to drug-induced falls. In one study, the main categories of drugs responsible for the falls leading to hip fractures were sleeping pills and minor tranquilizers (30%), antipsychotic drugs (52%), and antidepressants (17%). All of these categories of drugs are often prescribed unnecessarily, especially in older adults, according to medical experts that are not anti-drugs. The in-hospital death rate for hip fractures in older adults is 4.9%. Multiplying this times the 32,000 hip fractures a year in older adults attributable to drug-induced falls, 1,568 older adults die each year from adverse drug reactions that cause hip fractures.
  • Approximately 163,000 older Americans suffer from serious mental impairment (memory loss, dementia) either caused or worsened by drugs. In a study in the state of Washington, in 46% of the patients with drug-induced mental impairment, the problem was caused by minor tranquilizers or sleeping pills; in 14%, by high blood pressure drugs; and in 11%, by antipsychotic drugs.
  • Two million older Americans are addicted or at risk of addiction to minor tranquilizers or sleeping pills because they have used them daily for at least one year, even though there is no acceptable evidence that the tranquilizers are effective for more than four months, and the sleeping pills for more than 30 days.
  • Drug-induced tardive dyskinesia has developed in 73,000 older adults; this condition is the most serious and common adverse reaction to antipsychotic drugs, and it is often irreversible. Tardive dyskinesia is characterized by involuntary movements of the lips, tongue, and sometimes the fingers, toes, and trunk. Since most of the older people taking these drugs were not actually psychotic, they have a serious side effect from antipsychotic drugs prescribed without justification.
  • Drug-induced parkinsonism has developed in 61,000 older adults due to the use of antipsychotic drugs such as Haldol, Thorazine, Mellaril, Stelazine, and Prolixin. There are also other parkinsonism-inducing drugs, such as Reglan, Compazine, and Phenergan, prescribed for gastrointestinal problems. As mentioned above, most (about 80%) older adults receiving antipsychotic drugs do not have schizophrenia or other conditions that justify the use of such powerful drugs.

A serious problem exists because both doctors and patients do not realize that practically any symptom in older adults and in many younger adults can be caused or worsened by drugs. Some doctors and patients assume that what are actually adverse drug reactions are simply signs of aging. As a result, many serious adverse reactions are entirely overlooked or not recognized until they have caused significant harm.

The World Health Organization has stated some principles applicable to people of all ages: “Quite often, the history and clinical examination of patients with side effects reveal that no valid indication [purpose] for the offending drug has been present…Adverse reactions can to a large extent be avoided in the elderly by choosing safe and effective drugs and applying sound therapeutic principles in prescribing, such as starting with a small dose, observing the patient frequently, and avoiding excessive polypharmacy [the use of multiple drugs at the same time].”

In other words, according to the World Health Organization, patients who suffer adverse drug reactions are very often victims of drugs that there is no valid reason for them to take.

A carefully controlled study examined the details of prescriptions of people being discharged from a community hospital with three or more prescriptions to treat chronic illnesses. The results of this study are quite disturbing, both in what they say about the doctors’ prescribing practices and in the evidence as to the potential damage that could be done to older adults as a result of these practices. Of the 236 people intensively studied:

  • Eighty-eight percent of the people had one or more prescribing problems with the prescriptions they were given. At least one potentially serious, life-threatening problem occurred, which could have been as a result of the prescriptions written for 22% of these patients.

When the specific problems with the prescriptions were examined, the results were as follows:

  • Fifty-nine percent of the patients had been given one or more prescriptions for a drug that was an inappropriate choice of therapy because it was either “less than optimal medication given the patient’s diagnosis” or there was no established indication for it;
  • Twenty-eight percent of the patients were given too high a dose of the drug, an “overdose”;
  • Forty-eight percent of the patients were given a combination of drugs that can result in one or more harmful drug interactions;
  • Twenty percent of the patients were given drugs that unnecessarily duplicated the therapeutic effect of another drug they were taking.

The good news from this study, however, was that a consultant pharmacist, involved in the care of more than 50% of these patients, was able to reduce the risks by making recommendations to the prescribing physicians.

Available on the web site are lists of the most common drug-induced adverse effects along with the drugs that can cause them. In the box below are some of the symptoms that, although they are frequently caused by drugs, are the kinds of problems that you or many doctors might first attribute simply to “growing old” or “getting nervous” instead of to a drug.

Which Adverse Effects Can Be Caused by Which Drugs?

The drug-induced disease lists on this web site are to be used by patients who have any of a variety of medical problems (or by doctors) to find out which drugs, especially ones they are using or are considering using, can cause specific adverse reactions. The lists are compiled from a variety of sources.

Although some of these adverse effects occur most commonly in older adults, all of them have also been documented in younger people, although not as often in some instances.

SUMMARY OF ADVERSE REACTIONS AND THE DRUGS THAT CAUSE THEM
Only the most easily detectable problems are considered, and only the most common drugs causing each problem are listed.
Adverse Drug Reaction Number of Drugs Examples of Brand Names
Depression 166 Accutane, Advil, Catapres, Cipro, Dalmane, Factive, Inderal, Naprosyn, Norpace, Pepcid, Reglan, Tagamet, Talwin, Ultracet, Valium, Xanax, Zantac
Psychoses/ hallucinations 156 Aldomet, Benadryl, Catapres, Celebrex, Cipro, Dexatrim, Elavil, Halcion, Inderal, Lanoxin, Procanbid, Sonata, Tagamet, Ultracet, Valium, Vioxx
Confusion/ delirium 147 Amaryl, Ambien, Benadryl, Catapres, Cipro, Compazine, Diabeta, Diabinese, Dymelor, Elavil, Mellaril, Sinemet, Tagamet, Valium, Xanax, Zantac
Dementia 76 Aldomet, Inderal, Maxzide, Mellaril, Regroton, Restoril, Ser-Ap-Es, Tagamet, Valium, Xanax,Zantac
Insomnia 35 Avelox, Floxin, Inderal, Lasix, Mevacor, Nicorette, Sudafed, Synthroid, Theo-24
Parkinsonism 40 Abilify, Aldomet, Asendin, Cardizem, Compazine, Elavil, Geodon, Haldol, Mellaril, Prozac, Reglan, Regroton, Risperdal, Thorazine
Tardive dyskinesia 19 Abilify, Asendin, Buspar, Compazine, Geodon, Haldol, Mellaril, Risperdal, Thorazine, Wellbutrin, Zyban, Zyprexa
Dizziness on standing 154 Abilify, Calan SR, Cardizem CD, Cardura, Catapres, Compazine, Elavil, Geodon, Haldol, Hytrin, Inderal, Isordil, Lasix, Minipress, Nitro-Bid, Prinivil, Procardia, Sonata, Tenormin, Valium, Xanax
Falls/hip fracture 59 Ambien, Celexa, Compazine, Dalmane, Elavil, Haldol, Isordil, Lexapro, Navane, Nembutal, Prozac, Restoril, Sinequan, Valium, Xanax
Automobile accidents 28 Ambien, Asendin, Ativan, Celexa, Elavil, Lexapro, Norpramin, Pamelor, Paxil, Prozac, Sinequan, Tofranil, Valium, Xanax, Zoloft
Sexual dysfunction 127 Abilify, Calan SR, Geodon, Lopid, Lopressor, Norpace, Pepcid, Proscar, Prozac, Sarafem, Tagamet, Tegretol, Transderm-Scop, Zantac
Loss of appetite, nausea, vomiting 63 Advil, Avelox, Daypro, Demerol, EES, Feldene, Feosol, K-Lor, Lanoxin, Levaquin, Relafen, Sumycin, Theo-24, Ultracet, Ultram
Abdominal pain, ulcers, GI bleeding 48 Advil, Anaprox, Celebrex, Cortone, Daypro, Decadron, Feldene, Indocin, Motrin, Relafen, Somophyllin, Theo-24, Ultracet, Vioxx, Zithromax
Constipation 107 Amphojel, Benadryl, Caltrate, Cogentin, Inderal, Lotronex, Maalox, Talwin, Tylenol No. 3, Tylox, Ultram, Urised
Diarrhea 56 Aciphex, Aldomet, Avelox, Cipro, Dulcolax, Maalox, Phillips’ Milk of Magnesia, Nexium, Peri-Colace, Precose, Prilosec, Sporanox, Sumycin, Zelnorm
Lung toxicity 59 Cordarone, Feldene, Inderal, Prinivil, Tegretol, Vasotec, Visken
Blocked urination 56 Antivert, Artane, Benadryl, Bentyl, Compazine, Duragesic, Elavil, Felbatol, Haldol, Sinequan, Tavist, Ultram, Zyban
Urine leakage 84 Aricept, Celexa, Esidrix, Hytrin, Inderal, Lasix, Lexapro, Lithobid, Minipress, Neurontin, Paxil, Restoril, Tenormin, Valium, Xanax, Zaroxolyn, Ziac, Zoloft

The above was taken from: Worstpills.com (Public Citizen). Their site has the associated research citations.

So, we see from looking at only a few studies conducted mostly on the elderly, that what we’re led to believe is a careful science – the prescribing of pharmaceuticals – is often imprecise, arbitrary, and dangerous. And this is the not the opinion of natural doctors, but of doctors and researchers who generally see prescription drugs as the best way to treat disease.

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