Three Prescription Drug Risks for Older Adults and Caregivers
FDA Drug Warnings For Older Adults This summer the Food and Drug Administration (FDA) issued a number of warnings that should concern caregivers and the elders in their charge as well.
The FDA has announced new warnings for three different classes of medications:
You would recognize the brand names, Aleve, Motrin, Advil, or Nuprin as well as their generic names, naproxen or ibuprofen, and a lot of people use them to good effect.
Many people use these medications for their arthritis or other acute and chronic pain, and they are available over the counter (OTC) as well as by prescription.
FDA based its warning about NSAIDs in part on an international study titled INVEST.
Int this research 22,576 people were followed for nearly three years, and the American portion of this large group was followed nearly 8 years.
The overall study group included chronic and nonchronic NSAID users as well as people who were on no such medications.
Those using NSAIDs were more likely to suffer a non-fatal stroke, a myocardial infarction or heart attack or death from any cause than those not using NSAIDs.
In the long term follow-up, researchers found that people who already had a history of either blocked arteries to the heart or high blood pressure were even more at risk for an adverse event that the others.
The researchers suggested that people with high blood pressure or heart disease should look for some other alternative for their aches and pains.
Fortunately there are some alternatives for pain.
Cholesterol-Lowering Drugs The "family" of medications most commonly used to lower cholesterol is called statins and includes some very well-known brands that many of you have seen advertised on television and in magazines.
Others of you or the people you care for may also be taking these medications.
All Americans have been alerted to the risks posed by increasingly high levels of cholesterol many of us have in our bloodstreams owing to eating foods high in fats or just plain eating too much.
One way to address the elevated "bad cholesterol" or low density lipids (LDLs) is through diet and exercise.
But for people with persistently high LDL, a physician may also prescribe one of the many statins available.
These go by names like Crestor, Lipitor, Zocor, Levacor and Pravachol, and when taken as directed, they do help to reduce LDL levels.
Research published in the June 22-29, 2011, issue of the Journal of the American Medical Association looked at a number of individual studies which had shown a link between high-dose statin use and diabetes as well as a risk for cardiovascular events.
The researchers pooled the findings of five different and large clinical studies of moderate- and high-dose statin use among patients.
These studies followed patients for a number of years and the results over time were pretty compelling.
When the researchers compared the moderate and high-dose groups at the end of the nearly five years of the research, the high-dose group had 12 percent greater chance of developing type 2 diabetes than the moderate-dose statin users.
But the high-dose users of one of the statins, Lipitor, experienced a 16 percent lower likelihood of having some sort of cardiovascular event like a heart attack, stroke or even death.
The other statin studied did not offer any cardiovascular benefit.
It is not clear how other statins fared in terms of heart health.
The diabetes link was the most consistent across medications.
As with a lot of modern medicine, the devil is in the details.
It seems that high-dose statins pretty uniformly put patients more at risk than moderate-dose statins for diabetes.
It is important to appreciate that these are significant differences, but even then, the numbers of patients who may expect an issue to develop will be quite small.
Medications that Treat Anemia The third FDA warning was about some of the dosing for drugs that are used for people who may be anemic or suffer from chronic kidney disease or be on chemotherapy of some sort.
As you may suspect, this is a relatively smaller segment of the adult population, and as you will see here, it gets even smaller as we are mainly talking about people with chronic kidney disease.
But one of these medications has been part of one of my client's standard monthly routine for some time, so it struck closer to home.
You may know these drugs by their brand names if you or a loved one has one of the conditions.
The brand names are Procrit, Epotin or Aranesp, and they help the body increase the red blood cell count for people with some types of anemia.
These drugs, referred to as erythropoiesis-stimulating agents or ESAs, are also now known to increase patients' risk of cardiovascular events.
As with the other two warnings I have posted, these risks only became known over time as more and more people were given these medications.
This is because the actual cardiovascular events they can cause are still fairly rare.
All of these drugs already had warnings of some sort on their packaging, so doctors have been aware of those.
The new warnings, in fact, are most particularly a danger for patients whose medications move their hemoglobin levels above a given point.
These drugs were intended to replace the need for certain patients to have red blood cell transfusions which also pose their own risks.
The new guidelines have been made clear to doctors in new warnings on the package inserts of these drugs, and they specifically make it clear that patients with chronic kidney disease and on dialysis should be treated differently from patients who are not on dialysis.
We recommend a sit-down session with the patient's primary care physician to do a medication audit.
As geriatric care managers, we also can do these audits, but only your physician can prescribe medications.
If the doctor is not aware of the OTC pain meds a patient is on, then it is hard to make a good decision.
The other obvious right steps would be diet and exercise.
For high blood pressure and for arterial blockage, minimizing bad cholesterol in the diet and reducing weight are real winners.
As always, consult with a physician before embarking on any exercise or diet program.
If you or an elder or other special needs person for whom you are a caregiver have chronic kidney disease, you should talk with your specialist about steps that may be taken to minimize any unnecessary heart risks.
Click the link for more information on these drug risks and other important information for caregivers, please visit Charlotte Bishop's blog.
The FDA has announced new warnings for three different classes of medications:
- Those for pain and inflammation.
- Those that lower cholesterol
- Those that help treat anemia in some patients.
You would recognize the brand names, Aleve, Motrin, Advil, or Nuprin as well as their generic names, naproxen or ibuprofen, and a lot of people use them to good effect.
Many people use these medications for their arthritis or other acute and chronic pain, and they are available over the counter (OTC) as well as by prescription.
FDA based its warning about NSAIDs in part on an international study titled INVEST.
Int this research 22,576 people were followed for nearly three years, and the American portion of this large group was followed nearly 8 years.
The overall study group included chronic and nonchronic NSAID users as well as people who were on no such medications.
Those using NSAIDs were more likely to suffer a non-fatal stroke, a myocardial infarction or heart attack or death from any cause than those not using NSAIDs.
In the long term follow-up, researchers found that people who already had a history of either blocked arteries to the heart or high blood pressure were even more at risk for an adverse event that the others.
The researchers suggested that people with high blood pressure or heart disease should look for some other alternative for their aches and pains.
Fortunately there are some alternatives for pain.
Cholesterol-Lowering Drugs The "family" of medications most commonly used to lower cholesterol is called statins and includes some very well-known brands that many of you have seen advertised on television and in magazines.
Others of you or the people you care for may also be taking these medications.
All Americans have been alerted to the risks posed by increasingly high levels of cholesterol many of us have in our bloodstreams owing to eating foods high in fats or just plain eating too much.
One way to address the elevated "bad cholesterol" or low density lipids (LDLs) is through diet and exercise.
But for people with persistently high LDL, a physician may also prescribe one of the many statins available.
These go by names like Crestor, Lipitor, Zocor, Levacor and Pravachol, and when taken as directed, they do help to reduce LDL levels.
Research published in the June 22-29, 2011, issue of the Journal of the American Medical Association looked at a number of individual studies which had shown a link between high-dose statin use and diabetes as well as a risk for cardiovascular events.
The researchers pooled the findings of five different and large clinical studies of moderate- and high-dose statin use among patients.
These studies followed patients for a number of years and the results over time were pretty compelling.
When the researchers compared the moderate and high-dose groups at the end of the nearly five years of the research, the high-dose group had 12 percent greater chance of developing type 2 diabetes than the moderate-dose statin users.
But the high-dose users of one of the statins, Lipitor, experienced a 16 percent lower likelihood of having some sort of cardiovascular event like a heart attack, stroke or even death.
The other statin studied did not offer any cardiovascular benefit.
It is not clear how other statins fared in terms of heart health.
The diabetes link was the most consistent across medications.
As with a lot of modern medicine, the devil is in the details.
It seems that high-dose statins pretty uniformly put patients more at risk than moderate-dose statins for diabetes.
It is important to appreciate that these are significant differences, but even then, the numbers of patients who may expect an issue to develop will be quite small.
Medications that Treat Anemia The third FDA warning was about some of the dosing for drugs that are used for people who may be anemic or suffer from chronic kidney disease or be on chemotherapy of some sort.
As you may suspect, this is a relatively smaller segment of the adult population, and as you will see here, it gets even smaller as we are mainly talking about people with chronic kidney disease.
But one of these medications has been part of one of my client's standard monthly routine for some time, so it struck closer to home.
You may know these drugs by their brand names if you or a loved one has one of the conditions.
The brand names are Procrit, Epotin or Aranesp, and they help the body increase the red blood cell count for people with some types of anemia.
These drugs, referred to as erythropoiesis-stimulating agents or ESAs, are also now known to increase patients' risk of cardiovascular events.
As with the other two warnings I have posted, these risks only became known over time as more and more people were given these medications.
This is because the actual cardiovascular events they can cause are still fairly rare.
All of these drugs already had warnings of some sort on their packaging, so doctors have been aware of those.
The new warnings, in fact, are most particularly a danger for patients whose medications move their hemoglobin levels above a given point.
These drugs were intended to replace the need for certain patients to have red blood cell transfusions which also pose their own risks.
The new guidelines have been made clear to doctors in new warnings on the package inserts of these drugs, and they specifically make it clear that patients with chronic kidney disease and on dialysis should be treated differently from patients who are not on dialysis.
We recommend a sit-down session with the patient's primary care physician to do a medication audit.
As geriatric care managers, we also can do these audits, but only your physician can prescribe medications.
If the doctor is not aware of the OTC pain meds a patient is on, then it is hard to make a good decision.
The other obvious right steps would be diet and exercise.
For high blood pressure and for arterial blockage, minimizing bad cholesterol in the diet and reducing weight are real winners.
As always, consult with a physician before embarking on any exercise or diet program.
If you or an elder or other special needs person for whom you are a caregiver have chronic kidney disease, you should talk with your specialist about steps that may be taken to minimize any unnecessary heart risks.
Click the link for more information on these drug risks and other important information for caregivers, please visit Charlotte Bishop's blog.
