11 Dangerous Drugs

AARP Identifies Drugs Dangerous for Older Americans

In August of 2002, AARP published on the Web a report written by Christopher J. Gearon that identified 11 drugs that were particularly dangerous for older people.

“Drugs act differently in older people than they do in younger people, says Gearon. “The aging process takes away water and muscle tissue and gives us more fat tissue, which affects the way the body absorbs drugs. Older people generally require lower doses of medications, and the consequences of medication side effects can be more serious.”

The AARP report followed research on drug dangers for senior citizens by the Agency for Healthcare Research and Quality. They found, 33 drugs qualify as "potentially inappropriate" for older persons, according to research by Arlene Bierman, M.D., a senior research physician and geriatrician with the Agency for Healthcare Research and Quality (AHRQ), and other colleagues. Their research appeared in the Journal of the American Medical Association in December 2001.

An AHRQ-convened panel of researchers went a step further—identifying 11 drugs on the list that should be avoided entirely by older patients:

Barbiturates such as burabarbital, secobarbital, and pentobarbital. These sedative hypnotics, or tranquilizers, can cause unconsciousness and death in large doses. They also are associated with serious withdrawal problems.

Flurazepam. Similar to Valium, this drug can cause sedation, putting older people at increased risk for falls. Better agents and shorter-acting ones are available.

Meprobamate. This older drug used for the treatment of anxiety is very sedating and highly addictive.

Chlorpropamide. One of the first oral diabetes drugs, the drug can cause hypoglycemia, or low blood sugar. Shorter-acting and overall better drugs are available for older persons with diabetes.

Meperidine. Better known as Demerol, this drug is a narcotic and can be sedating. Safer alternatives are available.

Pentazocine. A narcotic known as Talwin, this drug acts as a painkiller. It causes confusion and hallucinations.

Trimethobenzamide. Tigan is an anti-nausea drug that has central nervous system side effects. More effective drugs are available.

Belladonna alkaloids. Along with the remaining drugs on this list, belladonna alkaloids relieve gastrointestinal spasms and generally should be avoided by older people. Side effects include dizziness, dry mouth and urinary retention.

Dicyclomine. Like belladonna alkaloids, this drug relieves gastrointestinal spasms and generally should be avoided by older people. Side effects include dizziness, dry mouth and urinary retention.

Hyoscyamine. Like belladonna alkaloids, this drug relieves gastrointestinal spasms and generally should be avoided by older people. Side effects include dizziness, dry mouth and urinary retention.

Propantheline. Like belladonna alkaloids, this drug relieves gastrointestinal spasms and generally should be avoided by older people. Side effects include dizziness, dry mouth and urinary retention.

"Most of those drugs are sedating and can cause confusion or dementia-like symptoms," says Colleen O'Brien-Thorpe, Pharm.D., president of Prescription Drug Consulting Services, Inc. of Annandale, Va., and a pharmacist with a doctorate in pharmacology.

Still, Bierman and colleagues found that nearly 1 million older patients in 1996 used one of the 11 dangerous medications. The prescribing and taking of inappropriate drugs "is a big problem and a common problem," says Bierman. A key reason why the drugs end up in older Americans' hands: The lack of basic training in geriatric medicine among most physicians and health care practitioners, says Bierman.

Medication errors can be serious and even deadly - 68 percent of medication errors reported to the U.S. Food and Drug Administration between 1993 and 1998 resulted in hospitalization, a threat to life, disability or intervention to prevent permanent damage. Almost 10 percent of the reported cases resulted in death. Of those fatal errors, nearly 50 percent occurred in patients aged 60 or older.

Medication errors occur for many reasons, including mistakes involving the packaging and labeling of drugs, communication-related problems, dispensing errors by pharmacists, confusion over similar-sounding drug names, lack of education among providers and consumers about drugs, and incorrect use by patients. Inappropriate prescribing by physicians and other providers is also a concern.

Over-the-counter medicines, herbals/supplements and vitamins that people commonly take also can cause serious problems, particularly when taken with certain prescribed drugs, adds Judith Salerno, M.D., deputy director for the National Institute on Aging.

Indeed, 37 percent of adverse medication effects involve older Americans, says Nicole Brandt, Ph.D., director of clinical and educational services at University of Maryland's Lamy Center for Drug Therapy and Aging.

Patients and their families are the last line of defense against dangerous drugs. In addition to avoiding the 11 dangerous drugs for older Americans, heed the following advice:

Keep track of all medications that you take—including over-the-counter drugs, herbal medicines and vitamins. (Also, track the drugs to which you are allergic.) Share this list with your doctor and pharmacist. Have your doctors review the list at each visit to ensure another doctor hasn't inappropriately prescribed medication—as well as to see if you still require all the drugs that you're taking.

Know the drugs that you're taking, what they're for, and how long you need to take them. Also ask your doctor about possible side effects—and what you should do if you miss a dose. Some drugs call for you to double up when you miss a dose, while doubling up on other drugs can be dangerous.

Read all labels to ensure you're getting what you've been prescribed. If the print is too small, ask the pharmacist to print the label in bigger type. And don't take medicines in the dark, particularly if you take more than one.

Review the dates on your medicines every four to six weeks. Toss out any expired drugs.

Don't take drugs prescribed for other people.

Visit the same pharmacy for all your medications, as the pharmacist will be able to better flag potential problems.

Call your doctor immediately if you have any problems, questions or concerns with your medicines.

Resist taking new drugs on the market just because they're new. Clinical drug trials rarely include older Americans, and it may take some time for a new drug to be on the market before the effects on older people are known.

Don't make independent decisions about starting or stopping a drug—or altering doses—without consulting your doctor. Some medications, for instance, can be addictive, and stopping them on your own could create problems.

Consider non-drug therapy. For some cases of arthritis, for example, exercise may be a better option than a drug.

Check out the How to Be Drug Smart guide on ModernMaturity.org. It's full of practical tips for taking your prescriptions.