polypharmacy & other drug issues

a comment on a NYTimes “Diagnosis” article:

I recently began monitoring my senior parents (Mom - 89 y.o., Dad - 90 y.o.) medications and medical care at their assisted living facility. On review of their medications, I found that they were both on medications that were redundant, unnecessary, contraindicated, or inappropriate for their age. I scheduled an appointment with their primary care physician to discuss and sent him an email listing my concerns.

When we met, he admitted that he didn’t know why my parents were on certain medications, didn’t know that certain medications should (almost) never be used in conjunction with other medications (i.e. trazodone and gabapentin), and was unaware that particular medications were inappropriate for seniors (i.e. Trinellix is the only anti-depressant approved for use in seniors). There is a large percentage of medications commonly used in seniors that can cause dementia-type symptoms, create an increased fall risk, or cause somnolence/forgetfulness - and a lot of these medications have alternatives that are much safer and don’t have the same risks of cognitive degeneration.

I’m not sure how to ensure that doctors and/or pharmacists are monitoring a patient’s information or if there’s a way to red-flag inappropriate or contraindicated medications - I just know that my father was laying in bed drooling, incapable of conversation, and wasting away until my interventions. Now, he’s able to have a conversation, sit-up, and play BINGO. It’s just so wrong on so many levels


another reply to the same article:

All medications have the possibility of severe toxic reactions.

A year ago a family member began exhibiting Parkinson like symptoms after taking COGENTIN to combat Tardive Dyskinesia, a side effect of psychotropic medication.

At first the individual reported being unable to perform well known physical tasks, then being unable to write, read, and maintain physical balance and balance the checkbook. As time progressed this individual then had difficulty in walking, talking, and standing, and swallowing. The doctors were perplexed at the rapid decline. Family members were besides themselves with worry and considered hospitalization and nursing home/rehab care.

A family member who is a social worker and had worked in a rehab facility began doing research and discovered an article that described the symptoms as having roots in the toxic effect of the drug COGENTIN. After reporting her finding to the attending physicians they began to wean the patient off the medication. As they did so the symptoms gradually disappeared, and today the patient is able to write, read, talk, stand…etc.

This led to me wonder how many people today are in rehab and nursing facilities as a consequence of adverse reactions to medication. If the family member had not done the research and discovered the article and reported the finding, where would this patient be today?

It is important that family members advocate for their loved ones as did this man’s [in the article] spouse.


I’d like to add that not every doctor explains negative reactions to drugs as some new medical condition.

When my husband developed a dry cough, our PCP replaced his lisinopril–taken for several years with no problem–with losartan, which did the trick. When his potassium spiked, she replaced losartan–again, taken for quite some time–with amlodipine, so at least our PCP is knowledgeable where possible reactions to the blood pressure medicines she prescribes are concerned.

DH’s neurologist agreed to take the hubster off keppra right away when he seemed to react badly to it. He agreed with me that preventing paranoia and defiance was more important than preventing possible seizures. Although it took a long time for him to suggest it, Depakote–which he was planning to use to replace olanzapine–has shown effectiveness against seizures (it’s not the usual reason to prescribe it, but that side-effect has been noted). And so far DH hasn’t had his every-5-weeks seizure (about 7 weeks now). And he relies on my accurate reporting–and has thanked me for it every time–on how DH copes with the psychoactive meds he tries (unlike ALZ, there are no drugs specifically for PPA so all you can do is try various drugs for worsening symptoms but nothing is directed at the cause–there’s no research on the rare cause of dementia). The neurologist also relies on me to adjust dosage and timing to find the best results. And he was of help in getting our drug insurer to cover olanzapine after they dropped it from their formulary. It’s not that expensive anyhow–less than $200/month at full price. when I pick up the refill this coming week, I’ll see what I’m charged. Last time it was just $10 more per month than previously.

And speaking of personal finance aspects of elder care, when my brother took over handling Mom’s bills, he reviewed her medication list. And noticed the same expensive eye drops that had been prescribed for him, and which he replaced with something OTC that worked about as well. So he called Mom’s facility’s dr and had him change the pharmacy order, saving Mom something like $150/month. That might not sound like much, but since Mom’s facility costs more than her monthly income, not ticking down her savings quite as fast may matter some day. And the fact that her POA dude is carefully perusing such things may make the dr think twice about what he prescribes to her (eg, not what a drug rep is pushing…if they still do that).

I’d like to add that not every doctor explains negative reactions to drugs as some new medical condition.

Usually that is the pharmacist. They always ask “do you have any questions” after they give you the basics (e.g. “take with food”, or “take an hour before eating”, or whatever). If it’s new, I’ll ask about interactions with current meds, and “can we expect any side effects”. And then I read the drug info paper they give us anyway.

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"When we met, he admitted that he didn’t know why my parents were on certain medications, didn’t know that certain medications should (almost) never be used in conjunction with other medications (i.e. trazodone and gabapentin), "

I may be missing something - but I do not know of problems with trazodone and gabapentin



So what is the problem with the two?
I assume something more severe than constipation?


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Re gabapentin and trazodone — a LOT more than constipation, especially for the elderly.

**Using trazodone together with gabapentin may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination.**


The ehealthme.com reference wasn’t looking at the interaction between these 2 drugs, but looking specifically and only at drug interactions that can produce constipation. But it doesn’t deal with what other interaction effects can occur with those 2 drugs. The other link involves a doctor—with no idea of their background/experience/qualifications—answering a question. That is not a supported or definitive answer by any means. And it’s not supported by those who know what they’re talking about.

Recently published research in mice points to the potential anti-pain value when used together in LOW DOSES FOR EACH. Very very different than both together at standard dosing.


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