Nine Rules for Safer Drug Use

Rule 1: Make sure drug therapy is really needed.

Drugs are often prescribed to treat situational problems such as loneliness, isolation and confusion. Whenever possible, nondrug approaches to solving these problems should be tried first, including taking up new hobbies, socializing with others and getting out of the house. When a person is suffering from depression after losing a loved one, for example, support from friends, relatives or a psychotherapist is often more effective than an antidepressant.

Nondrug therapies like weight loss and exercise are preferable to drug therapy for problems such as mild high blood pressure and mild type-2 diabetes. Increasing fiber and liquid in the diet is preferable to using laxatives for constipation. Wearing support hose is less expensive, safer and probably more effective than taking heart or water pills for swollen legs due to “bad” veins in the legs (not due to heart disease).

Drugs should rarely be prescribed for anxiety or difficulty sleeping, particularly in older adults.

Many of these drugs are dangerous and addictive. A last “disease” for which drug therapy is rarely, if ever, appropriate is any disease or adverse reaction caused by a drug. For example, the proper treatment for drug-induced Parkinsonism is stopping the use of the disease-causing drug — not taking a second drug to treat the problem.

Always talk to your doctor about whether a drug may cause side effects that are worse than the condition you want to treat. A common example of this is found in blood pressure drug treatment. These drugs are extraordinarily overprescribed to older people with slightly high blood pressure who don’t even have symptoms or problems caused by the high blood pressure. In most cases, drug treatment makes these people feel worse, with no evidence of any benefit. The guiding principle: Use as few drugs as possible to reduce adverse reactions and increase your odds of taking the drugs that are really necessary.

Rule 2: If drug therapy is indicated, in most cases (especially in older adults) it is safer to start with a dose that is lower than the usual adult dose.

When starting a drug, begin with as low a dose as possible. In other words, “Start low; go slow.” A lower dose will cause fewer adverse effects, which are almost always related to the size of the dose. Some experts suggest that the elderly start with one-third to one-half of the usual adult dose for most drugs. Next, they should watch for side effects, increasing the dose slowly and only if necessary.

Rule 3: When starting a new drug, see if it is possible to discontinue another drug.

If your doctor is considering adding a new drug to your treatment, this is an opportunity to re-evaluate the drugs you are already taking and eliminate those that are not absolutely essential. The possibility of an adverse drug interaction between the new drug and one of the old ones may lead to discontinuing or changing a drug anyway.

Rule 4: Regularly talk to your doctor about stopping your drugs.

At least every three to six months, review with your doctor your need to continue each drug being taken. For antibiotics and many mind-affecting drugs, such as sleeping pills, tranquilizers and antidepressants, this re-evaluation should be more frequent. The prevailing principle for doctors and patients should be to discontinue any drug unless it is essential.

Many adverse drug reactions are caused by continuing to use drugs for too long after they are needed. Many drugs, such as antidepressants, sleeping pills, tranquilizers and others that are prescribed for an acute problem, are not needed beyond a short period of time and eventually start causing risks without providing benefits. Slow and careful weaning off of these drugs may significantly improve a patient’s health.

In addition to considering whether to stop a drug, you and your doctor should discuss the possibility of lowering your dose. An exception to this is with the use of antibiotics, which should be used for the entire prescribed period of time, even if you are feeling better before having finished the prescribed dosage.

Rule 5: Find out if you are having any adverse drug reactions.

If you develop any adverse reactions after beginning to use a drug, contact your doctor. Ask if you really need a drug in the first place and, if you do, ask if a safer drug could be substituted or whether a lower dose could be used to reduce or eliminate the adverse effect.

If you or a relative of friend develop any new reactions (mental or physical) after starting a new drug, notify your doctor or tell your friend or relative to notify his or her doctor.

Another way to identify possible adverse drug reactions is to look up the name of your drug using the search function on WorstPills.org. After typing in the drug name, scroll down to the section in the drug profile containing details on adverse reactions caused by the drug.

The remaining rules for safer drug use (or nonuse) were compiled from a number of lists, but particularly from the World Health Organization’s General Prescribing Principles for the Elderly. These rules, however, apply to all age groups, and all doctors and patients involved in drug therapy should know them.

Rule 6: Assume that any new symptom you develop after starting a new drug was caused by the drug.

If you have a new symptom, report it to your doctor.

Rule 7: Before leaving your doctor’s office or pharmacy, make sure the instructions for taking your medicine are clear to you and a family member or friend.

Regardless of how old someone is, their chance of developing an adverse reaction from a drug is high enough that at least one other person — a spouse, child or friend — should know about the possibilities. This is especially critical for drugs that cause adverse reactions such as confusion and memory loss. For older adults, the complexities of drug use may be greater, especially for people taking more than one drug and people with physical or mental disabilities. In these cases, it is even more important to inform another person about possible adverse drug reactions.

Ask your doctor to make sure that the label on the drug states, if at all possible, the purpose for which the drug is being used. This is especially important when you are using multiple drugs. All information concerning the proper use of the drug should also be on the label. In addition to the drug label, you should get a separate instruction sheet and have it explained to you.

Rule 8: Discard all old drugs carefully.

Many people are tempted to keep and reuse drugs after their conditions have changed, which in itself is a dangerous idea. In addition, new drug treatments may make the older drugs much more dangerous when used in combination. You also may be tempted to give drugs, such as antibiotics, to a friend or relative who you believe may benefit from them. Resist these temptations and avoid further problems caused by using outdated drugs by throwing them away when you are done with your course of therapy.

Rule 9: Ask your primary doctor to coordinate your care and drug use.

If you see a specialist and he or she wants to start you on new medicines in addition to the ones you are on, check with your primary doctor first — usually an internist or general or family practitioner. It is equally important to use one pharmacist, if possible.

Next month, in the March 2011 Worst Pills, Best Pills News, we will explain the most important tip for safe drug use: Having “brown bag sessions” with your primary doctor and filling out a drug worksheet with him or her. We will provide you with a drug worksheet to help you keep track of all drugs you are using, the purposes for which they are being used, their side effects, their effectiveness, and other essential information.