By Bita Naderi, PharmD, BCGP

Note: This article is intended for informational purposes. It is important that you or your loved one(s) do not make changes to your medication(s) without first discussing with a physician or other prescribing healthcare provider.

Dr. Bita Naderi, PharmD, BCGP

People commonly believe that medications and supplements available to them over the counter must be safe. They are available, after all, without a prescription. However, over-the-counter does not necessarily translate to safe, and people should still exercise caution with these medications. Many factors go into determining safety: dose, duration of use, and interactions with other medications, among many others. Older adults often have multiple medical conditions, are on a variety of medications, and have physiological changes associated with aging that can put them at greater risk of adverse effects from medications. In fact, an outpatient study found people taking 5 or more medications had an 88% increased risk of an adverse drug event.

Considering that older adults account for 40% of all over-the-counter medication purchases, think about the following: Did you know that diphenhydramine (Benadryl®), often used for allergies and insomnia, may increase one’s risk of cognitive impairment, confusion, delirium, and dementia? Did you know that commonly used stomach acid suppressing medications, proton pump inhibitors, such as omeprazole (Prilosec®) when used over-the-counter, should be limited to 14 days of treatment? These medications are associated with increased risk of Clostridium difficile, a life-threatening bacterial intestinal infection, and impaired absorption of important vitamins and minerals such as calcium, iron, magnesium, and vitamin B12. Despite this, people sometimes use these medications indefinitely when not indicated. Did you know that commonly used non-steroidal anti-inflammatory drugs (NSAIDs), such as naproxen (Aleve®) and ibuprofen (Advil®), may carry an increased risk of heart failure exacerbations, stroke, heart attack, bleeding, and acute kidney injury?

And don’t forget about dietary supplements. Studies show that 70% of older adults use at least one supplement daily. Many herbs and supplements such as fish oil, garlic, and ginkgo biloba can increase the risk of bleeding, especially when used in combination with other medications that carry a bleeding risk. Some supplements, such as iron, magnesium, calcium, or aluminum, can impair absorption of some medications. You can discuss these drug interactions further with your pharmacist.

Paracelsus, the famous Swiss physician and alchemist of the 16th century, once said, “All things are poison, and nothing is without poison, the dosage alone makes it so a thing is not a poison.” In short, all medications, including those available over-the-counter, have the potential to cause harm if not used appropriately. In fact, we now know that is it not just the dosage alone that can impact safety, but a multitude of other factors. These include the person’s chronic disease states, other medications they are on, length of therapy, their ability to be adherent to a medication, and many others. These factors are unique from person to person. As such, every treatment plan must be individualized.

How can patients know if an over-the-counter medication or dietary supplement is safe for them? Pharmacists can serve as a great resource. Medication Therapy Management (MTM) is a growing field for pharmacists with the goal of improving therapeutic outcomes for patients. MTM aims to decrease the utilization of high-risk medications and medications that are ineffective or no longer indicated. MTM can decrease adverse drug events, drug interactions, and therapeutic duplications. Older adults can benefit greatly from MTM services, as many have multiple chronic conditions, complex medication regimens, and are experiencing growing healthcare costs. Furthermore, these patients often have multiple prescribers and multiple pharmacies. This is even more reason for a pharmacist to oversee and manage their medications as a whole, which when complicated by over-the-counter medications, can put them at greater risk for adverse drug events.

UC San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences (SSPPS) offers MTM services to clients through a program called Partners in Medication Therapy. UC San Diego SSPPS clinical faculty, who are also licensed and credentialed pharmacists, ensure effective and safe use of drug therapies according to recommended guidelines and best practices in order to meet treatment goals.

Windward Life Care clients can access the services of the UC San Diego SSPPS Partners in Medication Therapy program. Just contact us to find out next steps.

Dr. Bita Naderi is a California licensed and Board Certified Geriatric Pharmacist. She completed a UC San Diego geriatric pharmacy postdoctoral fellowship and served as a pharmacy consultant at a local Program of All Inclusive Care for the Elderly (PACE). She currently works as a pharmacist at Southern Indian Health Council and strives daily to optimize medication therapies and improve adherence.