- The Washington Times - Sunday, December 14, 2003

Some medicines don’t suit older folks because they could pose unacceptable hazards to an aging body, or simply are ineffective.

There are 48 of them, in fact.

So says a dozen doctors, geriatric psychiatrists, pharmacologists and other specialists who have issued a list of medications deemed “potentially inappropriate” for seniors — including Prozac, such over-the-counter preparations as Benadryl, Aleve and Dulcolax, and even plain mineral oil.

The list was published Dec. 8 in the “Archives of Internal Medicine,” a publication of the American Medical Association (AMA).

“We realize that aging is an individualized process, and there are some 65-year-olds who are healthy and do fine on these medications,” said Donna M. Fick, a geriatric nurse with the Medical College of Georgia and principal author of the panel’s report.

But with multiple medication requirements, chronic conditions and delicate constitutions, some seniors end up with side effects or unintentional overdoses from the very medicines meant to help them.

The report found that 30 percent of hospital admissions among the aged were prompted by troubles with their medications.

“The prevention and recognition of drug-related problems in elderly patients and other vulnerable populations is one of the principal health care quality and safety issues for this decade,” the panel’s report stated.

Benadryl made the no-no list because it “may cause confusion and sedation” in an older user. Mineral oil can be accidentally inhaled. Aleve could potentially produce renal and heart failure and gastrointestinal bleeding. Prozac can cause sleep disturbances and agitation.

“Safer alternatives exist,” the report said.

But project director Mrs. Fick also said the new criteria will “cause some controversy.”

The list, she said, is meant as a guideline rather than an absolute for physicians. And patients shouldn’t stop — or start — taking medications on the list without first consulting their doctor, she said.

One AMA study found that 35 percent of ambulatory older adults have experienced adverse reactions to their medications. Another AMA study revealed that 28 percent of these reactions were also preventable.

Common sense and an alert physician seems to be the cure.

“As we age, we have more subcutaneous fat, less lean body mass, less total body water. All those things conspire together to lead to increased drug toxicity and overdose,” Mrs. Fick said.

The “pharmacokinetics” — how the body actually uses a drug — changes with the slower metabolism of older adults. Drugs that were well-tolerated for years become unpredictable and sometimes lethal.

“The single most common problem that I see in my practice comes from the benzodiazepine group of tranquilizers like Valium and Xanax,” said Dr. Tom W. Jackson, a geriatrician who served on the panel.

“These drugs tend to calm people down, but they also disinhibit them. The effects are much like alcohol,” he added. “Folks who are on these medications are also much more likely to fall. They are actually four times more likely to fall and break their hip than people who are not on these medications.”

The panel’s research updates criteria established in 1997 by Dr. Mark Beers, who developed it for the well-known “Merck Manual,” a practical physician’s guide.

The complete list and full report can be read at the Archives of Internal Medicine Web site (https://archinte.ama-assn.org).


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