Friday, October 16, 2009

Are You Taking Too Many Medicines?

Johns Hopkins University
By Howard Levy, M.D. - Posted on Fri, May 02, 2008, 2:56 pm PDT

As many of us live longer with chronic conditions, the use of multiple medications at the same time - polypharmacy - is becoming common. And so are the problems that such multiple medication regimens can cause.

Good, evidence-based guidelines have helped doctors and patients better manage a variety of common diseases, like asthma, diabetes, and hypertension. Unfortunately, following all of this advice typically results in longer and longer medication lists.

Then there are remedies intended to treat, relieve, or reduce a variety of symptoms. Add to that the vitamins, supplements, and complementary and alternative therapies that many people choose to take, and the problem grows even larger.

Taking too many medicines can cause serious side effects, interactions, inconvenience, confusion, and expense. These issues get more complicated with every additional drug or supplement.

Children and seniors tend to be especially sensitive to these risks. Some guidelines suggest that people over age 65 should take no more than six medications. There's nothing magic about the number six, and the goal is to minimize their number to as few as possible.

This brings us to the art of medicine. Together with your health care provider(s), I suggest that you carefully consider the risks and benefits of every substance you take - whether it's natural or manufactured, whether it's traditional or alternative, and whether it's over-the-counter or prescription.

Here are some things to consider:

Which of my medications are necessary?
There are many medications that are necessary to control a disease or prolong life. A few examples include treatments for heart disease, diabetes, hypertension, or major depression. There may be few or no day-to-day symptoms associated with some of these conditions, so you may not feel any better (and sometimes feel worse) while taking these products. This list could be short or quite long and will be different for everyone, but the point is to identify and control conditions that are likely to cause major illness or death.

Which of my medications help me to prevent serious disease down the road?
This includes taking things like calcium to maintain bone density and aspirin to prevent future heart attack or stroke. There are lots of nutritional and alternative therapies in this category, many of which claim multiple potential benefits. Vitamins, antioxidants, and fish oil are a few examples.

Note that some of these drugs fall into the "necessary" category for people who already have the condition(s) they are intended to prevent. For the preventative medication category, I suggest weighing the evidence for how well a product achieves its goal against the importance of preventing the specific problem for which you are considering it.

Which of my medications are optional?
Optional medications are intended to improve your quality of life. In this definition, I'm including everything that isn't life-threatening. This list is long and includes conditions like pain, hayfever, gastritis, bowel or bladder problems, mild-to-moderate depression, poor sleep, and sexual dysfunction.

Often, the symptoms are severe enough that it isn't really practical to consider not treating them. Not surprisingly, this group includes some of the most heavily advertised and frequently requested drugs. They often provide significant recognizable benefits, so many patients choose to take them and accept more side effects, higher costs, and longer drug lists.

Regardless of which categories your medications fit into, it makes sense to use as few as possible and re-evaluate them periodically. Depending upon your health and your priorities, you may be able to reduce the number.





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