The Perils of Polypharmacy

Reprinted with permission from Dr. Julian Whitaker’s Health & Healing newsletter, copyright Healthy Directions, LLC

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Photo by DodgertonSkillhause, 2014 / morguefile.com

Allison came to Whitaker Wellness because her knee pain, urinary incontinence, heartburn, constipation, weight gain, insomnia, weakness in her legs, fatigue, and forgetfulness were getting worse, and all her doctors in Phoenix did was prescribe more and more drugs.

I ordered blood tests, did a physical exam, reviewed her medical records, and determined that she was quite healthy for a 75-year-old. Her most significant problem, which was causing most of her symptoms, was not a disease but her medication load.

Allison was taking eight prescription and four over-the-counter drugs daily, plus five more meds on an as-needed basis. She was a victim of polypharmacy: “multiple, excessive, unnecessary, or unindicated drug consumption.”

Inappropriate, excessive medications

Polypharmacy is a serious and increasingly common problem that makes patients sitting ducks for adverse side effects and dangerous drug interactions, raises risk of hospitalization and death, and drives up health care costs. People of all ages get stuck on this drug merry-go-round, but it’s especially common in older people, who are likely to have numerous medical issues, see several physicians, and receive multiple prescriptions.

A 2016 study revealed that 36 percent of Americans ages 62–85 are on five or more prescription drugs – many of them inappropriate for their age group – and 15 percent take drug combos that place them at risk of major drug-drug interactions.

Allison is a case in point. One of her meds was Ambien, a “hyponotic sedative” sleeping pill. Because Ambien’s side effects include next-day drowsiness, impaired alertness and cognitive function, and increased risk of falls and accidents, it is on the American Geriatrics Society’s list of potentially inappropriate medications for seniors. Yet it accounts for 21 percent of ER visits for adverse psychiatric drug reactions in people over age 65.

She also occasionally took Sominex to help her sleep. Diphenhydramine, the active ingredient in Sominex, Benadryl, and dozens of other over-the-counter antihistamines and sleep aids, belongs to a class of drugs called anticholinergics that are also inappropriate for older people. Side effects include constipation, sleepiness, confusion, and increased risk of dementia with longtime use. No wonder Allison was tired and forgetful!

Prescribing cascades

Polypharmacy also increases the likelihood of prescribing cascades, which result when adverse drug side effects are mistaken for new medical problems and even more drugs are prescribed. That’s exactly what happened to Allison.

For her knee pain, she was taking a prescription nonsteroidal anti-inflammatory drug (NSAID). NSAIDs are notorious for their gastrointestinal (GI) toxicity, especially in older people. Sure enough, Allison ended up with serious heartburn, so her doctor had her take Prilosec, a proton pump inhibitor that protects the GI tract but increases risk of dementia,

heart attack, and bone loss. She had also been prescribed Aricept, a drug that may help slow memory loss but has numerous side effects, including urinary incontinence. Not surprisingly, her incontinence worsened, so she was started on Enablex, another anticholinergic drug

that is associated with constipation and cognitive impairment.

In other words, this patient was prescribed medications to treat drug-induced side effects

(heartburn and urinary incontinence) that actually worsened her original problems!

“Deprescribing”

The first thing I did for Allison was get busy “deprescribing” – tapering or stopping her

unnecessary drugs. I discontinued her sleeping pills, tested her for sleep apnea, and started her on APAP to keep her airways open during sleep.

We treated her arthritic knees with platelet-rich plasma (PRP) and laser therapy and started her on glucosamine, fish oil, and curcumin to help rebuild cartilage and relieve inflammation.

Our nutritionist helped her clean up her diet, and she began exercising.

Guess what? Now that she was getting deep, restful sleep, she felt so much more energetic and clearheaded that she discontinued her “memory pills.” Over the next month, her urinary incontinence and constipation improved and she stopped the meds she had been taking for those conditions as well. As her knee pain improved and she weaned herself off NSAIDs, her heartburn cleared up and she discontinued Prilosec.

We also stopped the statin drug Allison had been prescribed, even though her total cholesterol had never been above 186 and she had no history of heart problems. Finally, we changed her Synthroid to natural thyroid. The weakness in her legs improved, and she began losing weight.

Bottom line, we cured Allison’s primary problem – polypharmacy – by discontinuing the bulk of her medications. As a result, most of her symptoms subsided and her quality of life dramatically improved.

Serious problem, simple solution

Adverse reactions to properly prescribed drugs result in 1.9 million hospitalizations every year, and another 840,000 patients experience life-threatening adverse medication events while in the hospital. All told, prescription drugs are responsible for 128,000 deaths per year, making this America’s fourth leading cause of death.

Polypharmacy obviously plays a central role in this colossal failure of conventional medicine. But there is a solution. We need to start thinking beyond medications. As Allison’s story demonstrates, there are many helpful, even curative non-drug interventions. Other examples include EECP, which dramatically reduces angina and medication requirements in patients with heart disease.

Weight loss and lifestyle changes lower blood sugar and allow patients to get off insulin and oral diabetes drugs. Prolotherapy, PRP, acupuncture, and other pain-relieving treatments reduce or eliminate reliance on painkillers. And targeted nutritional supplements can replace a whole slew of medications.

Patients need to step up as well – even if it means second guessing doctors’ recommendations. As Allison said, “One thing I learned at Whitaker Wellness was that I am in charge. I used to be afraid to question my doctors’ orders because I assumed they knew what they were doing. Now I know that isn’t always true. My health care is my responsibility and mine alone.”

References

Mortazavi SS, et al. Defining polypharmacy in the elderly: a systematic review protocol. BMJ Open. 2016 Mar 24;6(3):e010989.

Rochon PA, et al. Drug prescribing for older adults. Up to Date. 2016 Mar.

Scott IA, et al. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Intern Med. 2015;175(5):827–34.

About the Author

Dr. Julian Whitaker

Julian Whitaker, MD, America’s Wellness Doctor, is a graduate of Dartmouth College and Emory University Medical School. In 1979, he opened the Whitaker Wellness Institute, which has treated more than 45,000 patients and is the largest alternative medicine clinic in the country.

The author of the popular monthly newsletterRead more