When it comes to medication, less is more

Unless we’ve been incredibly healthy, we’re all familiar with the side effects of medication. We may take a drug to relieve pain, itching or heart attack risks, and end up drowsy, pudgy and unable to operate heavy machinery.
We typically accept those consequences as a small price for the relief of our original problem.
But we may not realize that taking more than one drug at the same time — or taking supplements in addition to medication — leaves us at risk of side effects from the interactions between them. The consequences may be severe.
Students of math know when we increase the size of a sample, the number of combinations within that sample increases very quickly. For example, if we are shopping and face a choice of two power-tools — or two purses — or two pastries, we have four choices. We can buy the first, the second, both or neither.
But as the supply increases, our choices multiply.
The number of options for a purse, power tool or pastry selection may be largely irrelevant; no matter how tantalizing the choices, we are likely to limit ourselves to one (okay two).
But when we surveyed our members, we found the typical CARP member takes four medications, with 11 per cent taking eight or more. This means older Canadians are at significant risk of severe side effects — not only from any one medication they take, but also from the many interactions that arise between multiple medications.
Thousands of medications are available, and pharmacists and doctors can’t know the possible side effects from all combinations of any two. When three or more drugs are prescribed, pharmacists are even less likely to know all possible side effects. But it is clear that polypharmacy, the simultaneous use of five or more medications by a patient, can lead to severe consequences. For example, a research paper published in Postgraduate Medicine in 2014, noted an increase in the risk of falls in older patients who were prescribed four or more medications.
While at times it’s clinically necessary to take multiple medications, too many Canadians are swallowing too many pills and running the risk of harmful side effects unnecessarily. Our healthcare system is very good at helping us get treatment (medication), but too few systems are in place to deprescribe it.
We may be taking a medication, such as a proton pump inhibitor (for acid reflux), when we could control our symptoms through gentler means. Or we may have become accustomed to a nightly sleeping pill — when the prescription was only meant for short-term relief. If a specialist prescribes us a medication, our family doctor may be reluctant to change or stop it. We may be prescribed a drug to help us prepare for an operation or other medical procedure, and inadvertently end up taking it long after the need has passed.
To be as healthy as possible, we need to pay just as much attention to coming off our medications as we do to going on them. Doctors and pharmacists can help assess our medications and provide advice and support to help wean us off of them.
It may be time to ask your doctor (or pharmacist), if less medication is right for you.
If you are taking medication for heartburn or acid reflux, click here for a guide to help determine if you still need to take it. Check out deprescribingnetwork.ca for information and other resources to help you identify ways to reduce the number of medications you take.
Grey Matters is a weekly column by Wanda Morris, the VP of Advocacy for CARP, a 300,000 member national, non-partisan, non-profit organization that advocates for financial security, improved health-care for Canadians as we age. Missed a week? Past columns by Wanda and other key CARP contributors can be found at carp.ca/blogs.