Polypharmacy’s Effects On Older Generations Of Americans: Hazards and Concerns
This is a discussion on polypharmacy, and its negative effects on the aging and elderly population in America. You may be asking yourself, What is Polypharmacy? Polypharmacy is the prescribing of multiple medications to the same patient. Most of the time, the patients who are affected by this are elderly, and they may have a variety of health conditions. Some examples would include high blood pressure, diabetes, or arthritis. While younger patients may have only one of these conditions, as patients age, they tend to continue to develop chronic conditions.
While this article will not delve into the benefits of changing one’s diet, adding exercise, or using vitamins and herbal medicines, all of these are legitimate options for an elderly patient. Of course, these different methods of handling chronic conditions would require a physician’s supervision, particularly by an Orthomolecular physician, nutritionist, or dietitian. Most individuals are not equipped with the proper knowledge and research skills to determine their own best plan. But that is a discussion for a later time.
Polypharmacy is a real problem, mainly due to the fact that the number of medications that have been studied together is not a high number. And, regardless of whether one or two have been studied together, if a patient is taking five or more different medications, what then? Well, the simple answer is that THEY are the guinea pig. They will be the determinant of the effects of these multiple drugs that interact together. The problem is, though, that the results of their ‘experiment’ don’t go anywhere. The FDA’s database is woefully incomplete, and if a polypharmacy patient has reactions to multiple drugs, which drug would the reaction be reported under? The FDAAERS system only allows patients to report reactions to one or another drug. If one is taking five or more, they can’t really report the adverse event for just one or another of the drugs they are on.
Doctors are inadvertently participating in this unethical practice, by prescribing multiple medications to the same patient. However, since each member of the patient’s healthcare team is of a different specialty, they often are not in communication. As a result, the urologist may prescribe something for low kidney function, then the general practitioner may prescribe a blood thinner or anti-coagulant, and at the same time, their ENT doctor may prescribe something for allergies. Many of these medications react to one another in the patient’s body in a different way.
This is especially true of blood thinners and anticoagulants, which tend to react with everything. Those types of pharmaceuticals have the longest list of drugs to not take together with it. This includes drugs, vitamins, and herbs. So, for a male patient experiencing Benign Prostate Hyperplasia, if they are on a blood thinner for a heart issue, they cannot take saw palmetto, for instance. Saw Palmetto has demonstrated prostate-shrinking ability, and can help the patient pass urine more easily. However, if they are on a blood thinner, they will be told not to take it. Instead, they can take another pharmaceutical drug that treats BPH, but this drug will also come with its own host of side effects.
One of the most common pharmaceutical drugs are the statin medications. The goal of many pharmaceutical companies that manufacture these drugs is to have every patient that is over the age of 55 and has high or moderately high blood pressure to be on these drugs. And they bring their own host of side effects as well as with a list of drugs they cannot be taken with.
Here is a list of the severe side effects from one of the statin medications (Crestor) (from PDR.net):
proteinuria / Delayed / 1.3-1.3
immune-mediated necrotizing myopathy / Delayed / 0-1.0
rhabdomyolysis / Delayed / Incidence not known
myoglobinuria / Delayed / Incidence not known
renal failure (unspecified) / Delayed / Incidence not known
pancreatitis / Delayed / Incidence not known
hepatic failure / Delayed / Incidence not known
Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) / Delayed / Incidence not known
angioedema / Rapid / Incidence not known
myasthenia gravis / Delayed / Incidence not known
And here are just a few of the drugs that this interacts with, many of which elderly patients may also be on. This is especially true of aspirin, antacids, and amoxicillin (also from PDR.net):
Acalabrutinib: (Moderate) Coadministration of acalabrutinib and rosuvastatin may increase rosuvastatin exposure and increase the risk of rosuvastatin toxicity. Acalabrutinib is an inhibitor of the breast cancer resistance protein (BCRP) transporter in vitro; it may inhibit intestinal BCRP. Rosuvastatin is a BCRP substrate.
Amoxicillin; Clarithromycin; Omeprazole: (Moderate) Monitor for an increase in rosuvastatin-related adverse reactions, including myopathy and rhabdomyolysis, during concomitant use with clarithromycin. Concurrent use may increase rosuvastatin exposure. Rosuvastatin is a substrate of the drug transporter OATP1B1/3 and clarithromycin is an OATP1B1/3 inhibitor.
Antacids: (Moderate) Coadministration of rosuvastatin with antacids has reduced rosuvastatin plasma concentrations by 54%. When the antacid is given 2 hours after rosuvastatin, no significant change in rosuvastatin plasma concentrations is observed.
Aprepitant, Fosaprepitant: (Minor) Use caution if rosuvastatin and aprepitant are used concurrently and monitor for a possible decrease in the efficacy of rosuvastatin. After administration, fosaprepitant is rapidly converted to aprepitant and shares the same drug interactions. Rosuvastatin is a CYP2C9 substrate and aprepitant is a CYP2C9 inducer. Administration of a CYP2C9 substrate, tolbutamide, on days 1, 4, 8, and 15 with a 3-day regimen of oral aprepitant (125 mg/80 mg/80 mg) decreased the tolbutamide AUC by 23% on day 4, 28% on day 8, and 15% on day 15. The AUC of tolbutamide was decreased by 8% on day 2, 16% on day 4, 15% on day 8, and 10% on day 15 when given prior to oral administration of aprepitant 40 mg on day 1, and on days 2, 4, 8, and 15. The effects of aprepitant on tolbutamide were not considered significant. When a 3-day regimen of aprepitant (125 mg/80 mg/80 mg) given to healthy patients on stabilized chronic warfarin therapy (another CYP2C9 substrate), a 34% decrease in S-warfarin trough concentrations was noted, accompanied by a 14% decrease in the INR at five days after completion of aprepitant.
Aspirin, ASA; Citric Acid; Sodium Bicarbonate: (Major) Coadministration of rosuvastatin with antacids has reduced rosuvastatin plasma concentrations by 54%. When the antacid is given 2 hours after rosuvastatin, no significant change in rosuvastatin plasma concentrations is observed.
Atazanavir: (Major) Initiate rosuvastatin at a reduced dosage of 5 mg once daily if coadministered with atazanavir; do not exceed a rosuvastatin dosage of 10 mg once daily. Concurrent use results in elevated rosuvastatin serum concentrations; thereby increasing the risk for myopathy, including rhabdomyolysis. Rosuvastatin is a substrate of the drug transporter organic anion transporting polypeptide (OATP1B1); atazanavir is an OATP1B1 inhibitor. Closely monitor for statin-associated adverse reactions, such as myopathy and rhabdomyolysis.
You can see by these lists that just one drug can carry its own long list of side effects and drugs it should not be taken together with. But many, many patients are taking drugs together that are on one another’s lists, they just don’t know it. Their doctors should know, but in many cases, they prescribe them anyway because it is more unethical, in their view, to allow the patient to suffer with whatever condition they have been diagnosed with than it is to be more conservative in their prescribing. If every physician consulted all of these lists before prescribing, it is likely that more elderly patients would take fewer medicines.
It must always be remembered, in addition, that contrary to popular belief, drugs are NOT vitamins. They are not vital minerals; they are ALL, without exception, poisons to a certain degree. No matter what it is you are taking, your body (including your liver and kidneys) will have to detoxify from them. So, if your kidneys or liver are not functioning well, that is going to be a problem for you. It is also true that there are medications that could literally be replaced by vitamins or herbs. BPH treatment by saw palmetto was mentioned previously. However, one of the easiest medicines to replace is blood thinners and anticoagulants.
Both Vitamin E and Vitamin K are on the lists of vitamins to stop taking when on blood thinners. This is because they both act as blood thinners, and Vitamin E is an anticoagulant. Vitamin K, however, is necessary for blood to clot, to such an extent that newborn babies can bleed uncontrollably if they have low Vitamin K. So, making people not take this drug will cause them to bleed more. Vitamin E is an anticoagulant as well as a blood thinner.
But outside of the risk of increased bleeding from both of these vitamins, which can include bruising more easily, there are no other side effects from these vitamins. With Vitamin E, in fact, the issues only become apparent when one is taking excessively high doses. And when it comes to increased bleeding, in general, the pharmaceutical blood thinners are much more persistent, and their effects can also be irreversible. This is why there used to be a black box warning for Warfarin, and patients taking it must have regular blood tests to make sure their blood isn’t being thinned too heavily.
What was said about the vitamins above cannot be said for blood thinning medications. They can and have caused life-threatening injuries, even leading to deaths in many cases. So replacing them with something non-toxic should be considered a great idea, not just a good idea. However, there is no profit in vitamins. The doctors and pharmaceutical companies, and our entire profit based medical system, are based on taking pharmaceutical drugs that have a high cost to the patient or their insurance company.
In order to avoid the issues related to polypharmacy, patients need to be their own advocate. Always ask if a drug is truly necessary, or if there is some lifestyle change one could make that would make it unnecessary. Or if there is an herb or vitamin that can replace it (your doctor will not know this). Be your own patient care representative, and do your best to take fewer medications, and only take those that are known to not interact with each other. You will be better off, since in many cases, the treatment can be worse than the disease. This is even more the case with polypharmacy, since the side effects you experience can be worse than the condition you are trying to treat, such as arthritis or high blood pressure. Make sure you know what you are taking, and take responsibility for your own treatment and healthcare.
Banner Image: Elderly woman. Image Credit – CDC
