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TenRulesforSaferDrugUse
Imageonhomepage:vallawless/Shutterstock.com
Rule1:HaveBrownBagSessionswithYourPrimaryDoctorFillOutaDrugWorksheet
(http://www.worstpills.org/public/drugsheet.pdf).
Itisimpossibletooveremphasizetheimportanceofthisfirstandmostcrucialstepinpreventingadverse
drugreactions.Wheneveryougotoadoctoryouhavenotpreviouslyseenortoonewithwhomyou
haveneverhadabrownbagsession,gatherallprescriptionandoverthecounterdrugsanddietary
supplementsinyourmedicinecabinetoranywhereelseandbringthemtothedoctorsothatalistcanbe
madeandyoucanstarttofilloutaDrugWorksheet(http://www.worstpills.org/public/drugsheet.pdf).
ThepurposeoftheDrugWorksheetisforyouandyourdoctor(ordoctors)tokeepanongoingrecordof
alldrugsyouareusing,thepurposesforwhichtheyarebeingused,adversereactions,whetherthe
drugisworking,andotherinformationessentialtothesafestandmosteffectiveuseoftheseproducts.
Doctorsshouldneverprescribeadrugorrenewaprescription,norshouldyoubewillingtogetanew
prescription,withoutfull,uptodateknowledgeofalldrugsalreadybeingtakenorlikelytobetaken.
Beforeyourbrownbagsessionwiththedoctor,yourpharmacistmayhelpyoutofilloutsomeofthe
blanksonyourDrugWorksheet(http://www.worstpills.org/public/drugsheet.pdf).
Onceyouhavebroughtinallthedrugsyouaretaking,askyourdoctortohelpyoufillouttheDrug
Worksheet.Youwillprobablybeabletofilloutmoreoftheinformationconcerningoverthecounter
drugsyourself,sincedoctorsoftendonotknowthatyouaretakingthemorforwhatpurpose.The
doctorwillbeabletohelpyoutofilloutmostoftheinformationconcerningprescriptiondrugs,atleastthe
onesthatheorshehasprescribedforyou.
ExplanationofItemsonDrugWorksheet
a.Nameofdrug,ofdoctorwhowrotetheprescription,anddatedrugwasstartedorthedosage
changed:Drugsshouldbelistedbybothbrandandgenericnames,sincebotharecommonlyused.All
drugsprescribedbyalldoctorsshouldbelisted.Overthecounterdrugsandtheamountofalcohol,
tobacco,andcaffeineusedshouldalsobeindicated.Therearemanydangerousinteractionsbetween
drugsandbetweendrugsandalcohol,sothisinformationisextremelyimportantinavoidingadverse
druginteractions.
b.Purposeofthedrug:Identifythereasonforwhicheachdrugisbeingtaken.Often,because
physiciansarefrustratedatnotbeingabletodoanythingelseforthepatient,orsometimesbecausethe
doctorbelievesthatthepatientwillnotbesatisfiedunlessapillisrecommended,prescriptionsare
writtenwithoutavalidmedicalreason.Inonestudy,patientsreportedthatoneoutofeveryfourtimes
(25.4%)theyreceivedaprescription,theywerenottoldthepurposeofthedrugbeingprescribed.1
c.Dose,frequencyofuse,anddurationofuse:Itisimportanttoknowwhatthedoseis,howoftenitis
supposedtobetaken,atwhathours,andforhowlong.
d.Whenthedrugshouldbestoppedortheneedforitsusereevaluated:Foranydrug,neworold,you
shouldassumethatitshouldbeusedforasshortatimeaspossibleunlessthereisevidencethatits
continueduseisnecessary.Anexceptiontothisistheuse,foraprescribedperiodoftime(evenifyou
arefeelingbetter),ofantibiotics.Evaluationatleasteverythreetosixmonthsoftheneedforeachdrug
beingusedwillreducethenumberofdrugsbeingtaken.Forsomedrugs,suchastranquilizers,sleeping
pills,antidepressants,andothers,muchmorefrequentreevaluationisnecessary.
e.Importantpossibleadverseeffectsofthedrug:Becausemanyofthemostseriousperceptible
adverseeffectsofdrugsareoftenwronglyattributedtosuchthingsasgrowingold(suchasfalling
(/go.cfm?type=druginducedchart&id=83),memoryloss(/go.cfm?type=druginducedchart&id=255),
depression(/go.cfm?type=druginducedchart&id=73),andmanymore),itisimportantforpatientsto
knowabouttheadverseeffectsofthedrugstheytakesotheycanrecognizethemandreportthemto
thedoctor.Inonestudy,researchersfoundthat37%ofdocumentedadversedrugreactionshadnot
beenrecognizedbypatientsandreportedtotheirdoctors,andthatthemajorityofthesepatientshadnot
beeninformedaboutpossibleadversedrugreactionsbytheirdoctors.1
f.Importantpossibledrugandfoodinteractions,especiallywithoverthecounterdrugs,anddiet
recommendations:Askyourdoctorwhichfoodsandotherdrugstakenalongwithyourdrugcaninteract
andcauseadverseeffects,andaskfordietaryrecommendations.
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g.Howyouareactuallytakingthedrug:Alwaysbestraightforwardwithyourdoctoraboutwhetherornot
youaretakingyourmedicineandhowoften.Dothisevenifyouhadnodefinedreasonforstopping.This
isimportantbecausenotgivingyourdoctorthisinformationcanleadtomistakenconclusionsabout
whatdosageordrugswork.
h.Newproblemsorcomplaintsnoticedbythepatient,friends,orfamilysinceanyofthedrugslistedon
theworksheethavebeenstarted:Asmentionedabove,patientsthemselvesoftendonotnoticea
change,especiallyolderadultswhoareinclinedtoblamemanyoftheirproblemsonaging.Friendsand
relativesareoftenthefirsttonoticeadversedrugreactions,especiallyonesthataffectthinkingormood.
Anadditionaldifficultyisthatpatientsareoftenreluctanttotelltheirdoctorsthatsomethingthedoctordid
totrytomakethembetteractuallymadethemworse.Thesafestassumptionisthatanyworseningofa
patientsconditionoranynewsymptomthatdevelopsafteradrugisstartedisanadversedrugreaction
untilprovenotherwise.
i.Inthejudgmentofyou,yourfamily,andyourdoctor,isthedrugworking?Havethepurposesforwhich
thedrugisbeingprescribed(asin[b])beenachieved?
Rule2:MakeSureDrugTherapyIsReallyNeeded.
Often,drugsareprescribedtotreatsituationalproblemssuchasloneliness,isolation,andconfusion.
Wheneverpossible,nondrugapproachestotheseproblemsshouldbetried.Theseincludehobbies,
socializingwithothers,andgettingoutofthehouse.Whenapersonissufferingfromanunderstandable
depressionafterlosingalovedone,forexample,supportfromfriends,relatives,orapsychotherapistis
oftenpreferabletodrugssuchasantidepressants.(Seediscussionontheproperuseofantidepressant
drugsfordepression(/go.cfm?type=otherpage&id=22).)
Nondrugtherapy,suchasweightlossandexercise,ispreferabletodrugtherapyforsuchproblemsas
mildhighbloodpressureandmildadultonsetdiabetes.(Seediscussionsofhighbloodpressure
(/go.cfm?type=otherpage&id=41)anddiabetes(/go.cfm?type=otherpage&id=11).)Increasingfiberand
liquidinthedietispreferabletousinglaxatives(seediscussionofdiarrhea(/go.cfm?
type=otherpage&id=31)).Forswollenlegsduetobadveinsinthelegs(notduetoheartdisease),
wearingsupporthoseislessexpensive,safer,andprobablymoreeffectivethantakingheartpillsor
waterpills.
Drugsshouldrarelybeprescribedforanxietyordifficultysleeping,particularlyinolderadults.Seeour
discussionofthisproblemandnondrugsolutions(/go.cfm?type=otherpage&id=20).
Alastcategoryofdiseaseforwhichdrugtherapyisrarely,ifever,appropriateisdruginduceddisease
oradversedrugreactions.Thepropertreatmentfordruginducedparkinsonismisnotaseconddrugto
treattheproblemcausedbythefirstdrug,but,rather,stoppingtheuseofthefirstdrug.
Foranycondition,alwaystalktoyourdoctoraboutwhethertheselecteddrugmaycauseproblems
(adverseeffects)worsethanthediseasebeingtreated.Acommonexampleofthisistheextraordinary
overtreatmentofolderpeoplewithslightlyhighbloodpressurebutwithoutanysymptomsoforproblems
causedbyhighbloodpressure.(Seeguidelinesfortreatmentofhighbloodpressure(/go.cfm?
type=otherpage&id=41).)Inmostcases,treatmentwillmakethepersonfeelworse,withnoevidenceof
anybenefit.Alwaysconsidertheseriousnessoftheconditionthatyourdoctorisconsideringtreating,
andtrytomakesurethatthetreatmentisnotworsethanthedisease.
Theguidingprincipleistouseasfewdrugsaspossible,inordertoreduceadversereactionsand
increasetheoddsofproperlytakingthedrugsthatarereallynecessary.
Rule3:IfDrugTherapyIsIndicated,inMostCases,EspeciallyinOlderAdults,ItIsSafertoStart
withaDoseThatIsLowerThantheUsualAdultDose.
Moregenerally,startwithaslowadoseaspossible.Inotherwords,Startlow,goslow.Alowerdose
willcausefeweradverseeffects,whicharealmostalwaysrelatedtodose.Intheelderly,someexperts
suggeststartingwithonethirdtoonehalftheusualadultdoseformostdrugsandwatchingforside
effects,increasingthedoseslowlyandonlyifnecessarytogetthedesiredeffect.
Rule4:WhenAddingaNewDrug,SeeIfItIsPossibletoDiscontinueAnotherDrug.
Ifyourdoctorisconsideringaddinganewdrug,thisisanopportunitytoreevaluateexistingdrugsand
eliminatethosethatarenotabsolutelyessential.Thepossibilityofanadversedruginteractionbetween
thenewdrugandoneoftheoldonesmayleadtodiscontinuingorchangingtheuseofadrug.
Rule5:StoppingaDrugIsasImportantasStartingIt.
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Atleasteverythreetosixmonths,regularlyreviewwithyourdoctortheneedtocontinueeachdrug
beingtaken.Formanymindaffectingdrugs,suchassleepingpills,tranquilizers,andantidepressants,
andforantibiotics,thisreevaluationshouldbemorefrequentandsooner.Theprevailingprinciplefor
doctorsandpatientsshouldbetodiscontinueanydrugunlessitisessential.Manyadversedrug
reactionshavebeencausedbycontinuingtousedrugslongaftertheyareneeded.Manydrugssuchas
antidepressants,sleepingpills,tranquilizers,andothersthatareprescribedforanacuteproblemarenot
neededbeyondashortperiodandcauseriskswithoutprovidingbenefits.Slowandcarefulweaningoff
thesedrugsmaysignificantlyimprovetheusershealth.Inadditiontoconsideringwhethertostopthe
drug,youandyourdoctorshoulddiscussthepossibilityofloweringthedose.Asmentionedabove,an
exceptiontothisistheuseofantibioticsfortheprescribedperiodoftime,evenifyouarefeelingbetter
beforehavingfinishedtheprescribeddosage.
Rule6:FindOutIfYouAreHavingAnyAdverseDrugReactions.
Ifyoudevelopanyofthefollowingreactionsafterbeginningtouseanydrug,contactyourdoctor.Askif
youreallyneedadruginthefirstplaceand,ifyoudo,whetherasaferdrugcanbesubstitutedor
whetheralowerdosecouldbeusedtoreduceoreliminatetheadverseeffect.Thiswebsitelistswidely
useddrugsthatcancauseeachoftheseadverseeffects.
mentaladversedrugreactions:depression(/go.cfm?type=druginducedchart&id=73),hallucinations
(/go.cfm?type=druginducedchart&id=112),confusion(/go.cfm?type=druginducedchart&id=25),delirium
(/go.cfm?type=druginducedchart&id=75),memoryloss(/go.cfm?type=druginducedchart&id=255),
impairedthinking,andinsomnia(/go.cfm?type=druginducedchart&id=77)
nervoussystemadversedrugreactions:parkinsonism(/go.cfm?type=druginducedchart&id=79),
involuntarymovements(/go.cfm?type=druginducedchart&id=81)oftheface,arms,andlegs(tardive
dyskinesia(/go.cfm?type=druginducedchart&id=80)),dizzinessonstanding(/go.cfm?
type=druginducedchart&id=258),falls(/go.cfm?type=druginducedchart&id=83)(whichcansometimes
resultinhipfractures),automobileaccidents(/go.cfm?type=druginducedchart&id=85)thatresultininjury
becauseofsedation,andsexualdysfunction(/go.cfm?type=druginducedchart&id=86)
gastrointestinaladversedrugreactions:lossofappetite(/go.cfm?type=druginducedchart&id=55),
nausea(/go.cfm?type=druginducedchart&id=59),vomiting(/go.cfm?type=druginducedchart&id=87),
abdominalpain(/go.cfm?type=druginducedchart&id=58),bleeding(/go.cfm?
type=druginducedchart&id=69),constipation(/go.cfm?type=druginducedchart&id=88),anddiarrhea
(/go.cfm?type=druginducedchart&id=24)
urinarytractadversedrugreactions:difficultyurinating(/go.cfm?type=druginducedchart&id=266)or
lossofbladdercontrol(incontinence(/go.cfm?type=druginducedchart&id=267))
Ifyouorarelativeorfriendhaveanyoftheaboveproblemsordevelopotherproblemsafterstartinga
newdrugandaretakinganyofthedrugslistedundertherespectiveproblem,notifyyourdoctorortell
yourfriendorrelativetonotifyhisorhers.
Anotherwaytoidentifypossibleadversedrugreactionsyoumaybehavingistolookupthenameof
yourdrugusingthesearchfunction(http://www.worstpills.org/search.cfm)onthissite.Thenscroll
doowntothesectioninthedrugprofilecontainingdetailsonadversereactionscausedbythedrug.
Theremainingrulesforsaferdruguse(ornonuse)werecompiledfromanumberoflists,butparticularly
fromtheWorldHealthOrganizationsGeneralPrescribingPrinciplesfortheElderly.2,3,4Theserules,
however,applytoallages.Alldoctorsandpatientsinvolvedindrugtherapyshouldknowthem.
Rule7:AssumeThatAnyNewSymptomYouDevelopAfterStartingaNewDrugMayBeCaused
bytheDrug.
Ifyouhaveanewsymptom,reportittoyourdoctor.
Rule8:BeforeLeavingYourDoctorsOfficeorPharmacy,MakeSuretheInstructionsforTaking
YourMedicineAreCleartoYouandaFamilyMemberorFriend.
Regardlessofhowoldsomeoneis,thechanceofadversereactionsishighenoughthatatleastone
otherpersonaspouse,child,orfriendshouldknowaboutthesepossibilities.Inthepresenceofsuch
adversereactionsasconfusionandmemoryloss,thisisespeciallycritical.Forolderadults,the
complexitiesofdrugusemaybegreater,especiallyforpeopletakingmorethanonedrugandpeople
withphysicalormentaldisabilities.Inthesecases,itisevenmoreimportanttoinformanotherperson
aboutpossibleadversedrugreactions.
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Askyourdoctortomakesurethatthelabelonthedrugstates,ifatallpossible,thepurposeforwhich
thedrugisbeingused.Thisisespeciallyimportantwhenyouareusingmultipledrugsbutisalways
importantasawayofincreasingyourandyourfamilysorfriendsparticipation.Allinformation
concerningtheproperuseofthedrugshouldalsobeonthelabel.Inadditiontothelabel,youshouldget
aseparateinstructionsheetandhaveitexplainedtoyou.
Rule9:DiscardAllOldDrugsCarefully.
Manypeoplearetemptedtokeepandreusedrugsobtainedinthepast,eventhoughtheirconditionhas
changed.Additionaldrugsusedmaymaketheearlierdrugsmuchmoredangerous.Inaddition,youmay
betemptedtogivedrugs,suchasantibiotics,toafriendorrelativewhoyoubelievemaybenefitfrom
them.Resistthesetemptationsandavoidfurtherproblemscausedbyusingoutdateddrugsbythrowing
themawaywhenyouaredonewithyourcourseoftherapy.
Rule10:AskYourPrimaryDoctortoCoordinateYourCareandDrugUse.
Ifyouseeaspecialistandheorshewantstostartyouonnewmedicinesinadditiontotheonesyouare
on,checkwithyourprimarydoctorfirstusuallyaninternistorgeneralorfamilypractitioner.Itisequally
importanttouseonepharmacist,ifpossible.
~~~~~

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1
GermanPS,KleinLE.Adversedrugexperienceamongtheelderly.InPharmaceuticalsfortheElderly.
PharmaceuticalManufacturersAssociation,Nov1986.

VestalRE,ed.DrugTreatmentintheElderly.Sydney,Australia:ADISHealthSciencePress,1984:2426.

DrugsfortheElderly.2nded.Copenhagen,Denmark:WorldHealthOrganization,1997.

CarruthersSG.Clinicalpharmacologyofaging.InFundamentalsofGeriatricMedicine.NewYork:RavenPress,

1983.

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