By Alan Peterson, M.D.

Older Americans comprise 13% of the population, but they consume an average of 30% of all prescription drugs.  Every day, physicians are faced with the issues surrounding appropriate prescribing to older patients.  Polypharmacy (which means the use of multiple medications in a patient), use of supplements, complying with instructions, and the potential for adverse drug effects all post challenges to effective prescribing.  Knowledge of the interplay between aging, chronic diseases and drugs will help the physician to help avoid potential adverse drug events as well as interactions between drugs and interactions between the drugs and the diseases that they are used for.

Evidence is now available showing that older patients may be under-prescribed many of the useful drugs, such as beta-blockers following a heart attack and coumadin for atrial fibrillation.  There are also many patients that might utilize aspirin for prevention for heart attacks especially if they are high risk.  Obviously all of these issues need to be discussed with your physician so that you know all of the pros and cons of the issues.

There is also evidence that many older adults that receive medications could potentially have harm from them.  Finding the right balance between too few and too many drugs will help insure increased longevity, improve overall health, and enhance functioning and quality of life for the aging population. 

Many people now are taking herbs as supplements to their medical regiments, but each herb can have potential drug interactions with other medications that they may be taking either over the counter or by prescription.  There are dozens of these.  For example, ginkgo can have drug interactions with aspirin, coumadin, certain diuretics which are used as fluid pills or high blood pressure medication, as well as acetaminophen, otherwise known as the brand name Tylenol.  St. John’s wort can have interactions with coumadin, digitalis (digoxin), and some antidepressants.  Ginseng can have interactions with alcohol, certain antidepressants, as well as coumadin.  Commonly used laxatives such senna and cascara can possibly interfere with any intestinally absorbed drug.  On the other hand, there are a few of these herbs such saw palmetto that there are no specific drug interactions at this time.

All of the above herbs mentioned also have potential adverse affects of their own without any drug interactions.  Try to make yourself aware of these potential drug interactions or adverse affects before you start taking these over the counter herbs.  There is a great deal of information these days on the internet.   Make sure that the information that you are getting is not being promoted by the company that is making them.  Obviously your physician can also be a source of information.

There are some known drugs with proven benefits in older adults.  Among these are:

Aspirin at the dose of a baby aspirin per day for those who have had a previous heart attack, coronary artery disease, transient ischemic attacks, angina, peripheral vascular  disease, stoke prevention, can be helpful.  Please discuss the use of aspirin and dose with your physician before starting, as there may be other reasons not to take it.  Drugs such as betablockers are also helpful after a heart attack.  These are usually continued for a year or until a complication might arise that would stop its use.

Any reduction in blood pressure appears to confer benefit and reduces stroke, coronary heart disease, cardiovascular disease, heart failure and mortality.  Multiple drugs might be utilized such as diuretics, beta blockers, and ACE inhibitors.  Home blood pressure monitoring can be very helpful in collecting data to help your physician and your treatment.

ACE inhibitors and spironolactone can help in decreasing complications from heart failure also. 

For those of you with high cholesterol, the statins have been very beneficial especially in those with coronary artery disease, previous stroke, diabetes, peripheral artery disease, carotid artery disease, and abdominal aneurysms.  These drugs include such well know medications as lipitor and zocor, among others.  It is best not to take grapefruit or grapefruit juice within 12 to 24 hours of these medications.