In this study the most frequently reported symptoms were: gastrointestinal problems, fatigue, dizziness, problems with balance, rash or itching, which all accounted for 55% of reported symptoms. But what did the researchers miss because they were not knowledgeable about the unexpected adverse effects of some medications? Just about any complaint that an older adult has can be medication-related. Think of all the adverse effects I’ve discussed on this site such as: urinary incontinence, muscle aches, memory loss, poor balance and falls, insomnia, among many others, all assumed to be age-related complaints. In summary, if you are experiencing what you think to be medication-related symptoms, have your medications reviewed in order to determine if a medication is affecting your function or quality of life so you can avoid unnecessary discomfort or harm.

Several medications have their absorption increased when not taken with food, to the extent that a substantial increase in absorption can lead to serious side-effects. Two examples of rather commonly used medications are Flomax (tamsulosin) and Coreg (carvedilol). When NOT taken with food, each of these drugs can cause a serious drop in blood pressure causing dizziness and perhaps a fall. Always take these medications with your usual meal.

Eye drops, when not administered properly, can lead to serious systemic, or body-wide, side-effects. Depending on the drug, those can vary between dizziness, falls, slowed heart rate, anxiety, generalized weakness, lethargy, depression, and more! The point is that if you take an eye drop that is known to cause effects on the body as a whole, you should use the “double DOT” technique for administering eye drops. This technique is referred to in our article on the systemic effects from eye drops. http://elderdrugs.com/2010/05/eye-drops-systemic-side-effects/. Eye drops that can cause these side-effects are: Timoptic (timolol), Cosopt, Alphagan (brimonidine), Prednisolone, Pilocarpine, among others.

For those that use steroid inhalers, like Advair (fluticasone/salmeterol), Flovent (fluticasone), Pulmicort (budesonide), among others, rinsing your mouth out after each use is critical in order to prevent several potential side-effects. First, swallowing the residual dose of a steroid inhaler can cause bone loss over the long run, that means increasing your risk for osteoporosis or thinning or weakening of the bones, and fractures. You may also experience fungal infections in the mouth, commonly called “thrush”. Lastly, although not common, assuming you use your inhaler later in the day or evening, you may experience insomnia from the steroid, or even anxiety. So, in short, always rinse your mouth out after using a steroid inhaler. And when I mean rinse your mouth out I mean, rinse, gargle, spit and repeat. I know it’s tedious, but once you appreciate the potential for side-effects you’ll work to adhere to that additional step.

So there you have just a few examples of how medications, when not administered properly, can cause side-effects, also called adverse effects. Keep in mind that many medications are associated with serious adverse effects when not administered properly. Have you learned all the right ways in which to take your medications? If not, Ask Your Pharmacist.

• Always look for non-drug options to manage your risk of disease. This is the best way to avoid over-medicating yourself. For example, non-drug methods to manage mild to moderate pain in osteoarthritis can be effective, yet the use of NSAIDs, drugs like ibuprofen or naproxen, are wrought with risk of GI bleeding, a leading cause of emergency room visits, hospitalization and death in older adults.
• Always make sure the benefits outweigh any risks since the benefit of many medications as we get older declines, while the risk of an adverse effect increases. This means you are holding your physician responsible by providing the clear evidence that what s/he wants to prescribe has clear evidence of benefit in older adults. Many times the prescriber is inferring from studies done in younger-old adults that the same benefit will be incurred in older adults. One such outcome was realized with the use of spironolactone for congestive heart failure. In younger-old adults it reduced hospital admissions and saved lives. But in older adults it increased hospital admissions and mortality rates, primarily due to high potassium levels. This is an adverse drug effect from spironolactone. This is a segue into the next key point.
• Get and stay engaged in your health plan by monitoring. Understand what you and your physician need to monitor in order to avoid serious adverse effects from your medications. Ask the question: What are possible adverse effects and how do we monitor to prevent them from happening? Is it blood sugar? Is it blood pressure? Etc. Take responsibility.
• When starting a new medication for a valid reason, ask your physician AND pharmacist if they checked for any and all drug interactions. This is critical! Several drugs were shown to be key in causing harm in older adults and led to emergency room visits because one drug caused an enhanced effect of another. A couple examples are: A sulfa antibiotic for a bladder infection added to someones regimen that contains an oral medication for diabetes, like glyburide or glipizide, and the result was severe low blood sugar. Or a potassium-conserving diuretic (water pill) added to someones regimen that contained lisinopril or enalapril and the result was severely high potassium levels, which can be lethal. Ask and don’t assume that drug interactions were screened whenever a new drug is added to your regimen, even if it is a short course for an antibiotic.
• Avoid taking medication known to cause harm in older adults. These are called PIMs or potentially inappropriate medications.  One such list is called the Beers List, developed by Dr. Mark Beers, MD. Many of these medications can cause cognitive impairment, over-sedation, contribute to or cause falls, among other things. Refer to our article “Beware! Drugs that may cause harm”.
• Take medications properly. One significant example is the use of eye drops. Timolol eye drops, when not administered properly get absorbed into the body and cause profound effects on blood pressure and heart rate. One study measured that timolol eye drops is the leading risk factor for falls in people with glaucoma. However, by using the proper method of administration you can reduce systemic absorption by 2/3rd’s thereby reducing the risk of any adverse effects. Refer to our article “Eye drops: Systemic side-effects”.
• Last but not least, whenever you feel different or just not right, always suspect a medication. My role is to presume a drug guilty until proven innocent. You should do the same and then hold the health care system accountable for investigating and ruling out all possible drug-related causes. When a client of mine told me his Zocor was causing memory loss I at first did not believe him. But we continued to purse his claim and, lo and behold, it is now accepted that statins do cause memory loss in some people. Always suspect the drug until proven otherwise and trust your instincts.

There you have it, your short guide to optimizing your health by optimizing your medication regimen.

Adverse Medication Events: The significance of eye drops causing side-effects in older adults

Adverse drug events (ADE’s), also called side-effects, are responsible for 2.2 million hospital visits and 106,000 deaths each year! If ADE’s were a disease by itself, it would be the 5^th leading cause of death by disease. This becomes more likely as we age since we are more sensitive to the effects of most medications and we tend to take more medications.

The most recent information we have is in relation to systemic side-effects from eye drops. One might assume that the effects of a topically applied eye drop would be limited to the area of the eye. However, the transit of medication through the tear duct into the body make many eye medications as potent as an intravenous (injected) dose of medication. Here are a couple ways to put this into perspective:

**One (1) drop of Timolol 0.5% Opthalmic Solution is as strong as one (1) 10 mg oral tablet used for treatment of hypertension or angina.

**The leading risk for falls in patients with glaucoma is the topical administration of (Timoptic) timolol eye drops.

Here are some examples of documented side-effects found in the literature:

1)          Bronchospasm and congestive heart failure (Timolol)

2)          Depression (Timolol & other beta blockers)

3)          Low blood pressure (Timolol & Pilocarpine)

4)          Headache or “brow ache” (Pilocarpine)

5)          Urinary frequency (Pilocarpine)

6)          Asthenia (Alphagan) Asthenia is defined as physical weakness and loss of strength

This is only mentioning side-effects from one drug at a time. Many older adults take up to four eye drops at the same time for their glaucoma. That being said, we need to pay closer attention to what’s going on. Here’s what we recommend:

1)   One way to reduce the drug from being absorbed into the body is to follow a particular technique. This procedure is called the “double DOT” procedure” which stands for “Don’t open eyes technique and Digital Occlusion of the Tear Duct” This involves closing the eye and applying pressure over the lacrimal duct (tear duct) for 1-2 minutes after application of the eye drop. This technique reduces systemic absorption by two-thirds.

2)   Describe what you might think are side-effects from the list mentioned above.

3)   Report those to the prescriber of those medications and/or consult your pharmacist. You may also consult Elder Drugs if you have concerns relating to your eye drops.