5 things to know when taking 5 or more medications
Drug interactions can cause dangerous side effects
The number of potentially dangerous drug interactions is impossible to estimate because the potential combinations of polypharmacy are virtually limitless. An example of a combination to avoid are blood thinners, such as warfarin, and nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen (Advil) or naproxen (Aleve). Taking these two together can increase your risk of bleeding.
For older people, cognitive issues such as memory problems, disorientation, confusion, and cloudy thinking are a major concern of taking multiple medications, explains Schneider. Falls too. And research shows that the more medication a person takes, the greater the risk of falling.
“A hip fracture in a 70 or 80 year old is really very serious and has major implications and effects on mortality,” explains Schneider. In fact, an elderly person’s risk of dying is twice as high in the first year after breaking up, one study shows, the risk remains nearly double for several years later.
Polypharmacy can affect brain health
While your daily medication regimen may be designed to improve your joint health or your mental health, it could negatively affect your brain health.
For starters, several studies have linked polypharmacy to dementia. Additionally, commonly prescribed medications, from antidepressants to corticosteroids, can cause cognitive problems that mimic dementia. However, unlike dementia, these symptoms are often curable, which is why Keller always considers medications when a person is concerned about their brain health.
“When someone comes in with suspected cognitive decline, the first thing we do is try to find a reversible cause,” he says.
Certain classes of drugs have also been linked to an increased risk of dementia, such as benzodiazepines, prescribed to treat conditions ranging from anxiety to insomnia, and anticholinergics, which are used to treat a range of conditions, including chronic obstructive pulmonary disease and gastrointestinal disorders. The over-the-counter allergy medicine, diphenhydramine (Benadryl) also has anticholinergic effects.
A 2019 study published in JAMA Internal Medicine found that long-term use of anticholinergics was associated with an approximately 50% higher risk of dementia, compared to short-term use.
It’s unclear exactly how the drugs might increase the risk of dementia, but a 2016 study found that the brains of people on long-term anticholinergics had atrophied and the hollow spaces inside had increased. Neurons also had a reduced ability to metabolize glucose. The higher the exposure to the drug, the more pronounced the effect.
Anticholinergics can also counteract drugs given to improve memory and thinking in Alzheimer’s disease, making it even worse. Three common drugs for Alzheimer’s disease (brand names Aricept, Exelon, and Razadyne) belong to a class called cholinesterase inhibitors. They work by increasing acetylcholine, a chemical that allows nerve cells in the body to communicate with each other, preventing its breakdown.
Anticholinergics do the opposite. They block the ability of acetylcholine to exert its effect, lowering nerve signaling, thereby decreasing any activity controlled by these nerves.