PREVENTING MEDICATION SIDE EFFECTS IN SENIORS

    Medication side effects hit seniors the hardest. Seniors sustain double or triple the incidence of side effects versus younger adults. Seniors may comprise only 19% of the population, but they account for 51% of deaths and 39% of hospitalizations due to medications.
    We know that seniors are more sensitive to medications. Experts agree that seniors should always be started on new drugs cautiously, starting with very low doses except in acute situations. For example:

Journal of the American Geriatrics Society: "Choosing the correct dose of a drug therapy is critical when prescribing for older people because adverse effects are often dose-related. The conventional wisdom has been to `start low and go slow (199947(8):954-9).'"

FDA Consumer Magazine: "There is evidence that older adults tend to be more sensitive to drugs than younger adults, due to their generally slower metabolisms and organ functions. ... The old adage, `Start low and go slow,' applies especially to the elderly (Sept.-Oct. 1997)."

    Despite this, for scores of top-selling drugs, drug company guidelines tell doctors to prescribe the same strong doses to young and old, healthy and frail, whether or not you are taking several other drugs. Each year, the problem seems to get worse as more and more drugs are developed, approved, marketed, and prescribed one-size-fits-all. Advertisements for doctors in medical journals actually boast that a drug doesn't have to be adjusted for older people. This sounds good to doctors because it saves time, but it doesn't sound good to patients or even conform with basic medical principles.
    Even when we know that blood levels of drugs such as Lipitor, Celebrex, Prilosec, Zocor, Zestril, and scores of others rise much higher in seniors, doctors are told to ignore this fact and prescribe the same strong doses anyway. And most doctors do. So is it any wonder that medication side effects are one of the top five leading causes of death year after year?
    What can you do? Unfortunately, little has been written on this topic. That's why I've addressed this issue in:

"Why Seniors Are at the Greatest Risk [and What You Can Do about It]." Chapter 8 in: Over Dose: The Case Against The Drug Companies. Prescription Drugs, Side Effects, and Your Health. Tarcher/Putnam, New York: October 2001.

"Adverse Drug Reactions: Effective Low-Dose Therapies for Older Patients." Geriatrics, Feb. 2000;55(2):54-64.

    I intend to write a lot more on this subject in my new books and subsequent newsletters. This problem is preventable. No one benefits when people get side effects, when doctors have to deal with them, insurers' costs climb, and drug companies lose sales because so many people quit treatment. We can end the side-effect epidemic now, and in doing so make it a win-win situation for all participants in healthcare today.

Copyright 2008, Jay S. Cohen, M.D. All rights reserved.

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