Common Drug Side Effects and Drug-Drug Interactions in Elderly Adults in Primary Care

Susan E. Merel, MD; Douglas S. Paauw, MD

Disclosures

J Am Geriatr Soc. 2017;65(7):1578-1585. 

In This Article

Abstract and Introduction

Abstract

Prescribing medications, recognizing and managing medication side effects and drug interactions, and avoiding polypharmacy are all essential skills in the care of older adults in primary care. Important side effects of medications commonly prescribed in older adults (statins, proton pump inhibitors, trimethoprim-sulfamethoxazole and fluoroquinolone antibiotics, zolpidem, nonsteroidal antiinflammatory drugs, selective serotonin reuptake inhibitors, dipeptidyl peptidase 4 inhibitors) were reviewed. Important drug interactions with four agents or classes (statins, warfarin, factor Xa inhibitors, and calcium channel blockers) are discussed.

Introduction

"One of the first duties of the physician is to educate the masses not to take medicine."
–William Osler

Appropriate prescribing, recognizing and managing medication side effects and drug interactions, and avoiding polypharmacy are all essential skills in the care of older adults in primary care. The Beers Criteria for Potentially Inappropriate Medication (PIM) Use in Older Adults is an essential reference for those prescribing to older adults but does not emphasize the most commonly used agents and covers only side effects and potential adverse effects of medications that are potentially inappropriate.[1] Recognizing a medication side effect may be the first step in treating an individual's presenting complaint and helps prescribers avoid the prescribing cascade, a contributor to polypharmacy in which a medication is prescribed to treat a side effect of another medication (Figure 1).[2]

Figure 1.

Representation of the prescribing cascade, with an example.

Appropriate prescribing in elderly adults is a complex endeavor that involves much more than avoiding potentially inappropriate agents and polypharmacy. Older adults, especially those with dementia, are often underrepresented in studies upon which guidelines informing prescribing are based, making it more difficult to make informed decisions about how much a particular medication is likely to benefit an older adult. The burden of frequent office visits for monitoring or titrating medications is greater in elderly adults, particularly those who are frail. It may also be more difficult to recognize drug side effects in older adults, especially those with multiple comorbidities and those with dementia, who cannot accurately report new symptoms. Drug side effects may be misattributed to a medical condition, or it may be difficult to determine which drug is causing a symptom.

Clinicians must be vigilant for drug interactions and side effects in elderly adults. Important side effects of drugs commonly prescribed to elderly adults in primary care and important drug interactions with four agents or classes (statins, warfarin, factor Xa inhibitors, calcium channel blockers) were reviewed. Many of the drugs discussed are among the most commonly prescribed drugs in older adults in primary care (Table 1).

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