Dr. Jena Burkhart, Pharmacist,
UNC Geriatric Specialty Clinic
Pharmacists today play a vital role as patients and medical providers seek expertise for appropriate and safe medications. The following pearls of wisdom provide information regarding prescriptions and over-the-counter (OTC) medications for adults 65+ to protect their health and avoid harm.
OTC labels indicate children have different dose requirements from adults, but did you know dosing for adults over the age of 65 is also different? As we age we have increasingly unique medical profiles which include balancing multiple health conditions and medications. Yet there is more to the story.
Pearl 1: As our bodies age, so does our ability to absorb, distribute, break down and eliminate medications. This means drugs may be absorbed slower, may not reach the needed level of impact or have too much impact, may be broken down more slowly by the liver and take longer to leave our body as kidney function declines.
Pearl 2: We are at greater risk for drug side effects. This is due to changes in our body as one ages, in combination with our unique medical profile. It is important that most medication changes start with a low dose and be increased slowly as indicated to meet treatment goals.
Pearl 3: Adverse drug reactions at age 65+ result in increased falls/fractures, changes in mental status, emergency room visits and hospitalizations. While this risk increases with aging, more medications and OTC agents amplify our risk.
Pearl 4: Adherence to drug regimens is important to minimize harms from drugs, such as dizziness, lightheadedness, and falls, and prevent events such as stroke and heart attack.
Pearl 5: Determining the appropriateness of OTC agents is equally important. Only your pharmacist or doctor can tell you if an OTC agent or supplement will compromise the effectiveness of your other medications. Always ask before starting.
Pearls of Wisdom in Daily Life
Osteoarthritis: Acetaminophen is usually a first line option for managing arthritis pain. Start with 1000mg 2x daily. If after 4-6 weeks pain is not controlled, take 1000mg 3x daily. (Low and slow) Long-term use of 4,000mg/day is highly discouraged due to possible liver damage and toxicity. Annual liver function tests are recommended. Always discuss with your provider before starting.
Cough and Cold: Avoid decongestant-containing products (pseudoepherine, phenylephrine) as they affect blood pressure. Avoid antihistamines (diphenhydramine, chlorpheniramine) as they can worsen/cause cognitive impairment, falls, constipation, urinary retention, and dry mouth/eyes. Safe alternatives include:
• Loratadine, cetirizine (10mg once daily) for runny nose/nasal drainage
• Saline nasal spray, warm nasal washes for nasal stuffiness
• Warm salt rinses, sugar-free throat lozenges for sore throat
• Guaifenesin (600mg 2-4 times/day), clear fluids for chest congestion
• Nasal Oxymetazoline (Max 3 days) for nasal congestion
if it is unresponsive to first-line treatments
Mood: The right prescription using low and slow dosing is extremely important. When being treated, our health conditions determine which medications will be safe. Self-administering an OTC or supplement treatments is highly discouraged.
Insomnia: See your medical provider to rule out medical causes and implement behavioral changes. Self-medicating (diphenhydramine, doxylamine) is highly discouraged as it can cause cognitive impairment, constipation, urinary retention, dry mouth and dizziness. If your doctor recommends an over-the-counter treatment, use melatonin, 1mg up to 5mg just before bed.
Utilizing medications appropriately is a complex balancing act requiring specialized expertise. Pharmacists today obtaining their Doctor of Pharmacy degree are uniquely trained to assist in this task, and is why today many are embedded in hospital care teams and in outpatient health clinics like the UNC Geriatrics Specialty Clinic.