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How to Be Drug Smart
By Russell Wild
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Just say no
Some drugs are so unpredictable when taken by older people that experts suggest you avoid them altogether, or take them in carefully calculated and monitored doses. Examples include the analgesic propoxyphene, the anti-inflammatory indomethacin, the antidepressant amitriptyline, and over-the-counter drugs containing diphenhydramine (Benadryl), chorpheniramine (Chlor-Trimeton), and most other nonprescription antihistamines. Ask your doctor and pharmacist whether a lower-than-standard starting dosage might be appropriate, given your age. For a list of high-risk medicines, check out The Merck Manual of Geriatrics, available at many libraries.
Act your age
As you grow older, your metabolism changes. The liver and kidneys may work more slowly. Body composition changes. The result is that your doctor may prescribe less medication to treat a problem when you're 70 than if you were 27. In fact, the dosages for an elderly person are often half of what a younger person might need (most drugs are not clinically tested on a large number of older people). And taking standard doses when you're older can lead to side effects. Some age-sensitive drugs, according to Cohen, author of Over Dose (Putnam, 2001):
- Antidepressants: citalopram (Celexa), bupropion (Wellbutrin), sertraline (Zoloft)
- Anti-inflammatories: naproxen (Anaprox), celecoxib (Celebrex), ibuprofen (Motrin)
- Antihypertensives: diltiazem (Cardizem), propranolol (Inderal), moexipril (Univasc)
- Cholesterol-lowering meds: atorvastatin (Lipitor), lovastatin (Mevacor)
- Ulcer and gastritis meds: omeprazole (Prilosec)
Following Your Medications' Rules
It's essential to stick with your doctor's plan
Beware of the crush
Some people pulverize their pills and put them in liquid. "Certain drugs will degrade and become less effective when crushed and put into a solution," says Abdelmacksoud. Some pills release medicine slowly. When these drugs are crushed, your body can absorb them too quickly. Drugs that should never be crushed: extended-release products (such as Procardia XL), enteric-coated pills (aspirin), and sublingual medications (nitroglycerin). If your doctor tells you to split pills, and they aren't scored, buy a pill splitter. But split your pills on the day you take them. (Doing it earlier may affect the medication.)
Use the right bottle
Don't make the common mistake of putting your pills in a different bottle. You could easily underdose on one medication, overdose on another, and forget which pill is for what. You could mistake a painkiller for a diuretic. The original bottle is also tinted or opaque to keep out light, which can degrade many meds. Storage instructions should be on the bottle and the package insert.
Don't drug and drive
Many medicines can cause fatigue and a slowing of reflexes. For example, a University of Iowa study found that the antihistamine diphenhydramine (Benadryl) caused more driving impairment than being legally drunk.
Leave yourself reminders
Keep forgetting to take your pills? A bevy of high-tech devices can provide you with reminders, from beeping chains and pagers to electronic pill containers and telephone or computer services. Low-tech methods include sticking notes to the bathroom mirror or refrigerator and other creative tricks. A lot of pharmacies will be happy to call and remind you that your prescription refill is due. So explore these and other options with your health care provider and your pharmacist.
Take 'em all
Only the hardiest bacteria survive the first few days of an antibiotic treatment. But if you quit before the infection is completely eliminated, those surviving bacteria will be fruitful and multiply. Not only that, but you'll be contributing to a serious public health hazard—the rise of antibiotic-resistant strains of bacteria. One other way to be part of the solution: Don't push your doctor to give you unnecessary antibiotics. Half of the antibiotics given to humans are prescribed for colds, coughs, and other viral infections, which aren't helped by antibiotics.
Send old drugs packing
You should always throw out your medications once they've passed their expiration dates. Try thinking of expired medicines as old car tires: They may still be functional, but the manufacturer can no longer guarantee their effectiveness. In some cases chemical decomposition can even turn a once-beneficial medicine into a poison. Use of outdated tetracycline (an antibiotic) has been linked to Fanconi's syndrome, a serious disease that can affect the kidneys and cause bones to soften. So review your medicines at least once a year and get rid of oldies that are no longer goodies.
Get medicine out of the cabinet
Drugs should be stored in a cool, dry place. Ironically, one of the worst places to keep medicines is in the medicine cabinet. "Bathrooms and kitchens tend to be the moistest spots in the house," says Diana J. Mason, RN, Ph.D., and editor-in-chief of The American Journal of Nursing. "A better place for medicines is inside a dresser drawer." If you have young grandchildren who visit, make sure you pick the top dresser drawer and that the child-safety cap is always secure. A chilling one-third of all accidental prescription drug poisonings in children involve a grandparent's medication. Red stickers with the nationwide poison control hotline number—800-222-1222—are available free by sending a SASE to Council on Family Health, Emergency Stickers, 1150 Connecticut Ave. NW, Suite 1200-B, Washington, DC 20036.
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