The top 20 medicines to avoid after age 65

PSM News /

June, 2016

Doctors across Canada are prescribing over $400 million a year in potentially risky medicines, whose harms, including death, often outweigh benefits in patients over the age of 65, a B.C.-led study shows.

And if indirect costs like hospitalizations stemming from side effects like drug interactions, falls and fractures are included, the costs of such “common, wasteful, and risky” prescribing practices goes up to $1.8 billion, according to a study published.

Said lead Author Steve Morgan, a Professor in the school of population and public health at the University of B.C:

“It’s a pattern that needs to be addressed. Doctors are very good at putting patients on new drugs but not so good at stopping by taking patients off of them.” 

The study measured the frequency and cost of inappropriate prescribing of drugs known to be potentially risky for older adults. Drug prescriptions for hospitalized patients were not included.

Among the several disturbing findings was that the prevalence of such inappropriate prescribing actually increased as patients got older. For example, 47 per cent of women aged 85 or older were repeatedly prescribed potentially risky medicines like benzodiazepines (tranquilizers) and other hypnotics.

“It’s definitely troublesome,” Morgan said, while noting that bold new mandatory prescribing standards, recently introduced by the College of Physicians and Surgeons of B.C should help curtail prescribing of sedatives and other potentially hazardous medications that seniors metabolize differently than younger patients. Earlier this month, College Registrar Dr. Heidi Oetter acknowledged that physicians play a role in the “over-prescribing” of opioids, sedatives and stimulants. Hence, the new College standards which are intended to reduce inappropriate prescribing of certain drugs like those in the current study.

Morgan said patients repeatedly prescribed sleeping pills like Zoplicone can become addicted to them and while no one is suggesting “draconian prohibition” of such medications, doctors could instead advise patients with insomnia to use alternatives like mindfulness and cognitive behavioral therapy.

Dr. Morgan also said, “I think many doctors are pressured to prescribe certain medications like sedatives by patients. And if they are seeing patients who were prescribed these pills by other doctors they feel pressure not to make any changes.”

While doctors may feel too rushed to talk with patients about whether they are taking the right medications, “these are important conversations to have” and he suggests adult children get involved in such discussions about pills their parents are taking. In addition to patient education, Morgan said the study results clearly show that more continuing medical education is necessary for doctors. The study concludes that if Canada adopted a national strategy like Australia has, which co-ordinates safe prescribing strategies, there could be cost savings to the health care system, not to mention benefits to patient health. 

Top 20 Medications to Avoid in the Elderly 

 

  • Lorazepam
  • Nitrofurantoin 
  • Amitriptyline 
  • Quetiapine 
  • Clonazepam
  • Zopiclone
  • Conjugated estrogens
  • Glibenclamide 
  • Indomethacin
  • Terazosin
  • Oxazepam
  • Risperidone
  • Estradiol
  • Temazepam
  • Metoclopramide
  • Amiodarone
  • Meloxicam
  • Cyclobenzaprine
  • Diclofenac combinations
  • Alprazolam

 

CMAJ Open