Every visit to your doctor should include medication review
Q I'm in my 70s. Every day I take 10 medications, many of which I have been taking for years. How do I know if all of these drugs are still necessary?
A: You've asked an important question. It should be a part of every medical visit for your doctor to review your medicines.
There are several reasons that I say this. First, doctors' visits these days are pretty short. We often feel rushed to cover everything in the time available. Even though we should be reviewing the medicines that a person is taking, we sometimes don't.
Second, particularly when people see more than one doctor, they can sometimes be on more medicines than are necessary. One doctor may even prescribe a medicine that has a negative interaction with a medicine another doctor has prescribed.
Third, our bodies change as we get older. Our kidneys and liver clear drugs from the body. As we age, these two organs clear drugs more slowly. As a result, drugs remain at higher levels in the blood for a longer time. That means a dose of a drug that was optimal for you 20 years ago may be too high today.
People also gain fat and lose muscle mass with age. This shift also changes the way drugs are distributed to and broken down in body tissues.
Fourth, more drugs are available without prescription these days. People are taking more over-the-counter medications than they did 20 years ago. That includes vitamins, minerals and other supplements. These medicines, too, can have negative interactions with prescription medicines.
Because drugs stay in the body longer as we age, their side effects can be more severe. I spoke to my colleague Dr. Sarah Berry, assistant professor of medicine at Harvard Medical School. She noted that the following medications are especially likely to have significant side effects in older people:
• Benzodiazepines. These medications are used to treat anxiety or insomnia.
• Medications containing diphenhydramine. This drug is found in allergy medications and sleep aids.
• Antidepressants. Both older, tricyclic antidepressants and newer antidepressants known as selective serotonin reuptake inhibitors (SSRIs) can cause worrisome side effects.
• Sleeping pills. These drugs cause next-day drowsiness and increase the risk of falls and fractures.
The next time you see your doctor, bring all of your prescription and over-the-counter drugs and supplements with you. Just put them in a bag. It's much easier than writing down a list of your medicines. And if your handwriting is as unclear as doctors' handwriting can be, the written list may cause problems.
And sometimes the drug or dose your provider thinks you use isn't exactly the same as the one you are taking.
Bringing in everything is a good way for the doctor to see what you're taking. Finally, ask your doctor the same two questions of every drug in the bag: "Do I need to be taking this?" and "Could I get by with a lower dose?" It's an entirely appropriate question, and your doctor should be pleased, not annoyed, that you've asked it.
• Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.