Adverse drug effects in the elderly We all know that prescribed drugs frequently lead to adverse effects. This is particularly true in the young and the elderly. A survey some years ago underlined this fact and suggested that any symptom in an elderly person who is taking medication should be considered to be a drug side-effect until proved otherwise. Gurwitz J, Monane M, Monane S, Avorn J. Polypharmacy. In: Morris JN, Lipsitz LA, Murphy K, Bellville-Taylor P, eds. Quality Care in the Nursing Home. St. Louis, MO: Mosby-Year Book; 1997:13-25.
Co-proxamol to be discontinued
The commonly used painkiller, Distalgesic (a mixture of paracetamol and dextropropoxyphene) accounts for 42% of all paracetamol-containing prescriptions yet it is to be removed the UK market in 2005. This is because it is not particularly effective and it carries the risk of serious problems if taken to excess, either accidentally or deliberately - dextropropoxyphene is a morphine relative. I remember prescribing huge quantities of this drug in my conventional days and it is still a popular painkiller. It is interesting to note that many years of its use leads to a conclusion that its 'efficacy is poorly established'.
Statins
Statins, cholesterol lowering agents, are also in the news about their effectiveness and safety. An article in the Sunday Times in the UK revealed that whne journalists had their serum cholesterol levels estimated at different laboratories on the same day, there were widely differing reading - from 4.7 to 6.8. This basis of deciding upon treatment with statins is often suspect.
In additions, statins are powerful drugs with life-threatening adverse effects in some people. In extreme cases, they can lead to muscle damage that can cause kidney failure. However, at a milder level, I find that many patients lose weight and muscle mass leading to a thin appearance and weak muscles. I encourage people to look at other methods of reducing cholesterol including diet and relaxation. Some people use supplements, whilst constitutional treatemt in beneficial in correcting underlying imbalances.
The message I gleaned from this article is not to completely trust cholesterol tests. The 'normal' levels have been fluctuating (usually downwards) in recent years and this fits in nicely with a programme of cholesterol demonisation and the recommendation of life-long drug treatment. Having said that, different laboratories have different 'normal' values. For example, here in Cork the upper level of normal is usually 5.0 (down recently from 5.2) but I saw a patient recently whose serum cholesterol of 5.5 was judged to be normal because the laboratory used an upper level of normal as being 5.6!
If any of you have shares in pharmaceutical companies producing statins, it may be an opportunity to review your portfolio. Now is the time you would expect more adverse publicity about statins. They have been on the market long enough for people to begin to wake up to their problems.
Read the label
Here in Ireland, a recent survey showed that almost 50% of people do not read information leaflets when they receive their non-prescription medication. I am sure that this is also true of prescription medication. I know from my experience of giving people herbal medicines, that people do not read the labels. I have adive on the label about what to take and when, not to take them during a fever or menstruation. Yet, months later, I find that people still take them during an acute fever or during menstruation.
The whole question of what information we give people and how we give it is interesting. Certainly writing down advice about diet, exercise and how to take medicines means that people are more likely to remember. Surveys asking people what they remember after seeing their doctor show that we retain very little of what we are told. Anyone who has been to school, college or attended lectures knows how little can remain in our brains!
