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Guidelines for Safe
and Effective Drug Use

Polypharmacy

Unfortunately, the cure can become the disease. Patients who are cared for by several physicians may end up with several drugs prescribed separately by more than one physician for different disorders-often without appropriate communication between patient and prescriber. This frequent practice can lead to serious drug-drug interactions. The patient should routinely talk to each health care provider about a11 the drugs prescription and nonprescription-that he or she may he taking. It is mandatory that each prescriber has this information before prescribing additional drugs.

DRUGS AND THE ELDERLY

Advancing age brings changes that can alter how you react to medicines. An impaired digestive system may interfere with drug absorption. Declines in liver and kidney ability to metabolize and remove drugs may lead to toxic drug levels. We slowly lose the ability to maintain "steady state" (or homeostasis), and face increased sensitivity of many tissues to the actions of drugs, even in "normal" drug doses. If aging causes a decline in understanding, memory, vision, or coordination, these patients may not always use drugs safely and effectively. Adverse reactions to drugs occur three times more frequently in the older population. An unwanted drug response can change an independent older person into a confused or helpless patient. For these reasons, drug treatment in the elderly must always be accompanied by the most careful consideration of the individual health and tolerances. Once-daily dosing may be the only viable option.

Guidelines for the Use of Drugs by the Elderly

• Be certain that drug treatment is necessary. Many health problems of the elderly can be managed without the use of drugs.
• Avoid (if possible) the use of many drugs at one time.
• Dosing schedules should be as simple as possible. Once a medicine is selected, ask your doctor if a once- or twice-a-day formulation is available and appropriate.
• Treatment with most drugs is often best started by using less-thanstandard doses.
• Tintenance doses should also be individualized and are often smaller for those over 60 years of age.
• Avoid large tablets and capsules if other dosage forms are available. Liquid forms are easier for the elderly or debilitated to swallow.
• Have all drug containers labeled with the drug name and directions for use in large, easy-to-read letters.
• Ask the pharmacist to package drugs in easy-to-open containers. Avoid childproof caps and stoppers.
• Do not take any drug in the dark. Identify each dose of medicine carefully in adequate light to be certain you are taking the intended drug. To avoid taking the wrong drug or an extra dose, do not routinely leave medicines on a bedside table. Drugs for emergency use, such as nitroglycerin, are an exception. It is best to have only one such drug at the bedside for use during the night.
• Drug use by older people may require supervision; watch constantly to ensure safe and effective use.
• Remember the adage: "Start low, go slow, and (when appropriate) learn to say no."