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For many people, swallowing a handful of pills is a daily ritual, from young adults struggling with anxiety to seniors dealing with chronic conditions.
Overall, 13 percent of people in the US take five or more prescription medications, compared to 42 percent for people 65 and older.
However, people who take multiple medications should be aware of potential problems. One pill can lead to a side effect, which leads to another pill and another side effect in what experts call a “prescribing cascade.”
Some medications can be harmful if taken for years. Others stop working or work poorly with a new medication. A medication that is initially well tolerated can cause side effects later, leading to cognitive decline and injuries from falls.
“Our metabolism changes as we age,” said Dr. Elizabeth Bayliss, a researcher at Kaiser Permanente’s Institute for Health Research in Aurora, Colo. “Everyone’s ability to metabolize the medications they’ve been taking for a long time can change.”
Bayliss studies write offa planned and guided process of reducing or stopping medication intake.
Medication overload, as the non-profit organization calls it Lown Instituteis a situation expected to cause 4.6 million hospital visits this decade.
If your daily pill-popping routine is getting out of hand, ask for a medication review. Here’s how to get started.
Request a prescription check
Start with a professional you trust, such as a doctor or pharmacist, says Lisa McCarthy, a pharmacist and drug tapering expert at the University of Toronto.
If you do ask your doctor, don’t wait until the end of a 15-minute visit. Instead, make a special appointment and tell them when you book that you want to talk about your medications, McCarthy said.
Your doctor may not have the full picture of what you’re taking if other prescribers are involved, and some doctors are hesitant to cover medications prescribed by others. In that case, a pharmacist can help by reviewing everything and writing down suggestions you can share with your doctors, says pharmacist Bradley Phillips of the University of Florida College of Pharmacy.
“We are seen as the drug experts,” Phillips said.
Is my medication a problem?
Swelling, incontinence, restlessness, insomnia — these are all side effects of common medications that are sometimes treated with new drugs. McCarthy wants people to ask their doctors a simple question: Could this symptom be related to one of my medications?
“If we could teach the public to ask that question, that would be very powerful,” McCarthy said. And as a follow-up question, she suggested asking whether the problematic drug is still needed.
Healthcare providers, patient groups and governments aim to reduce inappropriate prescriptions for seniors by 50 percent by 2020
Pharmacist Barbara Farrell sees dramatic changes in many of the people she serves at an outpatient geriatric center in Ottawa.
Some have emerged from drug-induced dementia after their medications were reduced. A 77-year-old woman was able to get out of her wheelchair and walk with a cane after cutting her daily pills from 32 to 17. She was sedated and unable to communicate, and a few months later she was back to her hobby of knitting.
Tapering off medication takes time
Some medications can be stopped abruptly, but others require a slow taper to avoid unpleasant withdrawal symptoms or even life-threatening seizures. Tapering to gradually lower doses is especially important for medications for depression, insomnia, and anxiety.
After two decades of taking various pills for these conditions, Spokane, Washington, therapist Molly Bernardi began tapering off her dosages.
The 45-year-old suspected the pills were the cause of her worsening digestive problems, balance, memory, stiff muscles and flickering dots in her vision. When scans ruled out other illnesses, she gradually stopped taking each of the four medications.
“It was by far the hardest thing I’ve ever done,” Bernardi said.
One of the last drugs she quit was the most powerful: a benzodiazepinesa class of tranquilizers that can be harmful if taken long-term. For three months, she used a kitchen knife and a nail file to cut her daily one-milligram pill into smaller and smaller pieces.
She listened to her body, found support groups on Facebook, and used breathing techniques and prayer to get through the withdrawal symptoms.
“Now when I have a good day, a good hour, a good moment, it’s a peace and a presence like I’ve never known since before I got on medication,” Bernardi said. “I just experience a little bit of awesome. And a little bit of awesome is so awesome that it keeps me going.”
Manage your medication list
Even in the best-connected health care systems, McCarthy said, prescription information isn’t always shared between doctors. And they won’t know about your over-the-counter medications, vitamins or nighttime CBD sticky.
The only person who knows what you’re taking is you, McCarthy said. So keep an up-to-date list of what you’re taking, why it was prescribed and when you started taking it.
McCarthy said a medication list is a “tremendously powerful” tool. McCarthy and her colleagues created workshop material designed to help people safely stop or reduce their medication use.
The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.
