November 6, 2016

Are the Meds You’re Taking Really Appropriate? A Reference for Older People

Most medications – both prescription and over-the-counter -- are not tested on older people. Nobody knows for sure what dosages are really appropriate for this demographic.

I've written about the subject before. I've noted that I usually begin with half the recommended dosage shown on the pill bottle whenever I start a new med.

Last week, I stumbled across a report on the internet that referenced an important source of information about the effects on older people of many well-known medications: the American Geriatrics Society's 2015 updated Beers criteria for potentially inappropriate medication use in older adults. Turns out it’s one of the most frequently cited reference tools in the field of geriatrics.

"As we grow older, at least one in six of us is likely to experience serious side effects directly related to the medications we take," said Todd P. Semia, co-chair of the AGS Beers criteria panel.

The main table in the Beers criteria includes a list of potentially inappropriate medications for most older adults. When I examined that list, I found one of my own prescribed meds on it -- nifedipine. My blood pressure (BP) doctor prescribed this drug for me to use when I get temporary BP spikes during my “off periods,” when the carbidopa-levodopa I take for Parkinson's disease is wearing off.

For all the potentially unsafe medications, the table shows the recommendation, the quality of the evidence supporting the recommendation, and the strength of the recommendation. For nifedipine, the recommendation was to avoid it; the quality of the evidence was high; and the strength of the recommendation was strong.

I'm not too concerned about this particular "red flag," since I take nifedipine only as needed, and never more than 1/3 of a pill. However, I had been taking it more frequently these days, since I'm trying to cut back on the carbidopa-levodopa... a reduction that can lengthen my off periods and raise my BP. 

 Now when I get a high BP reading – over 180 systolic (upper number), for example -- I’ll first try meditation to lower the number… and it usually works. As a result, I've used nifedipine only once in the past week, and only part of one pill.

I've alerted my prescribing doctor about this development, but haven't heard back yet.

You may well find that some of the meds you take are on the list, which includes aspirin and NSAIDs.

Beers Criteria and Parkinson's Disease
The Beers criteria also include a separate table that identifies meds that may even exacerbate the disease or syndrome they’re designed to treat in older people.

The list of potentially inappropriate PD meds includes:
  • All antipsychotics (except aripiprazole, quetiapine, clozapine)
  • Antiemetics
  • Metoclopramide
  • Prochlorperazine
  • Promethazin

 To check out the 2015 Beers criteria, click here.

1 comment:

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