John J. Whyte, MD, MPH
Director, Professional Affairs & Stakeholder Engagement
U.S. Food and Drug Administration
Millions of people use pain relievers every day and when used correctly, these medicines are safe and effective. As we age, we may find ourselves using these medications more often than in the past. Making sure we use them according to the label directions is important because they can really take a toll on our health when not used correctly.
The key is making sure you know the active ingredients of, and directions for, all your medicines before you use them.
Many over-the-counter (OTC) medicines that are sold for different uses actually have the same active ingredient. Also, active ingredients in OTC medicines can be the same as ingredients in prescription medicines. For example, a cold-and-cough remedy may have the same active ingredient as a headache remedy or a prescription pain reliever.
There are two basic types of OTC pain relievers. Some contain acetaminophen and others contain non-steroidal anti-inflammatory drugs (NSAIDs). These medicines are used to temporarily reduce fever, as well as temporarily relieve the minor aches and pains associated with:
- minor pain of arthritis
- muscle pain
- menstrual pain
- the common cold
We’ll focus on acetaminophen here. Acetaminophen is a common pain reliever and fever reducer, but taking too much can lead to liver damage. The risk for liver damage may be increased if you drink three or more alcoholic drinks while using medicines containing acetaminophen. Continue reading
Stephanie Trifoglio, MD, FACP
Private Practice Internist & Geriatrician
As a geriatrician, I see all of my patients myself, carefully take their history, and review all of their medications, both prescribed and over the counter (OTC). One patient’s story highlights why this is still very important and worth the time and effort.
A new patient, Mrs. B, came to me for help in managing her dementia. Her husband was remodeling their home to make it accessible as she was now barely able to walk. She was becoming more confused. She had previously seen an internist and two neurologists. Her husband gave a history of Parkinson’s disease, along with a several-year history of colitis and longstanding diarrhea.
The initial history revealed that Mrs. B. had progressive weakness, unsteady gait, and confusion. She had muscle jerks at night. She had three recent car crashes and subsequently stopped driving. She had even lost her ability to do sudoku. This was significant as she had been a doctorate-level biologist. A review of her medications showed that she had four years of taking Pepto-Bismol, two tablets, four times per day, prescribed for collagenous colitis. She took this dose consistently.
The active ingredient in Pepto-Bismol is bismuth, and I have never before had a patient take this much bismuth. Being naturally curious, and always looking for potentially reversible causes of dementia, I did a bit of research and ran basic blood tests on Mrs. B. I also instructed her to stop taking the bismuth. Continue reading
Does the number of medications you’re taking sometimes seem too high? Maybe it’s time for you and your healthcare provider to give your medication list a check-up by taking a closer look at the prescription and over-the-counter (OTC) treatments you take.
As you grow older, you’re more likely to develop health conditions that require taking multiple medications—some of which you may take for a long time. Many older people also take OTC medications, vitamins, or supplements as part of their routine care. As a result, older adults have a higher risk of overmedication, also known as “polypharmacy”—the medical term for taking four or more medications at the same time. Polypharmacy can increase your chances of unwanted reactions (also called “adverse drug reactions”) due to medications taken on their own or together.
To address this increasingly common problem, healthcare providers are focusing on how to reduce the number of medicines older adults are using through a practice called “deprescribing.” Dr. Michael Steinman, a member of the American Geriatrics Society (AGS) and a geriatrician at the University of California, San Francisco, recently appeared on WPUR—Boston’s NPR News Station—to discuss deprescribing with Dr. Barb Farrell, a pharmacist from Bruyère Geriatric Day Hospital in Ottawa, and Laura Landro, assistant managing editor at the Wall Street Journal. Hear what they had to say.
Want access to more tips and tools to help you manage multiple chronic conditions or multiple medications? We’ve got you covered.
Donna M. Fick, PhD, RN, GCNS-BC, FGSA, FAAN
Todd P. Semla, PharmD, MS, AGSF
Co-Chairs of the 2015 Updated AGS Beers Criteria Expert Panel
Today, the American Geriatrics Society (AGS) released its 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. For more than 20 years, the Beers Criteria have served as a valued resource for healthcare professionals about the safety of prescribing medications to older adults. In fact, the AGS Beers Criteria have become one of the most frequently used reference tools in the field of geriatrics. The AGS Beers Criteria were previously updated in 2012.
How We Updated the Beers Criteria
The 2015 Updated AGS Beers Criteria reflect work done by a panel of 13 geriatrics experts convened by the AGS. The panel searched for clinical trials and research studies since the 2012 AGS Beers Criteria were issued, and found more than 20,000 results! From this pool, our team reviewed more than 6,700 studies. From there, we were able to identify more than 40 potentially problematic medications or classes of medications, which we organized into five lists. While these lists aren’t exhaustive, they can be very helpful as conversation-starters between older adults and their healthcare providers about what treatment options work best from one individual to the next.
In addition to updating two lists of medications that may be potentially harmful for people aged 65 and older who are not receiving palliative or hospice care, the 2015 Updated AGS Beers Criteria now contain:
- Separate guidance on avoiding 13 combinations of medications known to cause harmful “drug-drug interactions.” Some medications may be inappropriate when prescribed together because they can increase an older adult’s risk for falls, fractures, or urinary incontinence, for example.
- A list of 20 potentially problematic medications to avoid or for which doses should be adjusted depending on an older person’s kidney function. These medications could raise risks for problems such as nausea, diarrhea, bleeding, problems affecting the brain and nervous system, and changes in mental well-being and bone marrow toxicity (a condition in which bone marrow makes fewer blood cells).
- Three new medications and two new “classes” of medications added to the Criteria. An example of a new class of medication includes the proton-pump inhibitors that some people take for acid reflux or stomach ulcers. Recent studies have linked these medications to an increased risk for bone loss, fractures, and serious bacterial infections, which is why they were added to the 2015 AGS Beers Criteria.