Prescription and non-prescriptions medicines offer many potential benefits for the control of symptoms and cure of diseases. Yet, taking too many medications increases the risk of adverse side effects and drug interactions and can get very expensive.

In my work as a consultant pharmacist I frequently see seniors who are taking 10, 12 or even more prescription and non-prescription medicines. The individual may be benefitting from all of the medicines they are taking but all-too-often I see situations where people are taking medicines that previously provided them benefit but now are no longer needed.

Here’s an example of how this can happen. The class of medicines known as “proton pump inhibitors”(PPIs) includes include the prescription drugs Nexium, Prevacid, Prilosec, Protonix and others and, in some cases their non-prescription versions which come in lower doses. As a class the PPIs reduce the production of stomach acid and are used to prevent or treat a variety of conditions ranging from minor heart burn to serious stomach and intestinal ulcers. They are also commonly prescribed in hospitals for the prevention of stress ulcers.

In spite of recommendations that they be used for limited periods of time for many conditions PPIs are often continued for months or years -- long past the time they should have been stopped! The reason for this is explained by a familiar saying used by senior care health professionals which is, “It’s a lot easier to start a medicine than it is to stop one.” In my experience this is true but by taking positive steps this type of unnecessary medicine use can be avoided.

Starting a medicine is easy. A prescription is written and filled or a non-prescription drug is purchased in a pharmacy but then the hard work begins. It is important that, at the beginning, the goals of therapy are specified including what the desired results are, when they should be expected to be achieved, and very importantly, what action will be taken if the goal(s) are not reached, including stopping the medicine and initiating some other intervention. If these questions aren’t asked it is common that therapies be continued long after they are needed.

The PPIs are a great example because, for many years they have been thought of as safe and effective medicines but recent studies indicate that long-term use of higher doses might increase the risk of fractures, pneumonia and infections. This new data points out how important it is to stop therapy when it is no longer needed.

Many other medicines are often used longer than they should be including tranquilizers and sleep medicines originally used to treat a temporary condition but continued too long because the questions noted above had not been asked.

You can participate in your drug therapy by asking your prescriber the following questions when a new prescription is written: 1. What is the goal of this medicine? 2. When can I expect that achieve that goal? and 3. What are the next steps if the goal(s) is not achieved? When you purchase a non-prescription medication you can ask the same questions of yourself or discuss with family members.

These simple steps will go a long way to help prevent the use of medicines that are no longer necessary.

About Dr. William Simonson

William Simonson is an independent consultant pharmacist responsible for the development of clinical and educational activities designed to improve drug therapy in the elderly. He is active in lecturing, research and senior care pharmacy practice and is involved in a consultant pharmacy practice with nursing home and assisted living residents.  Dr. Simonson has been active in the area of geriatrics and long-term care pharmacy practice for more than thirty years.  He has more than 150 publications on the subject, is the author of two books, Medications & the Elderly: A Guide for Promoting Proper Use and Consultant Pharmacy Practice (editions 1 and 2).