Medication lists are like coffee tables. First, you just place the TV remote on it. Then, maybe next week you place that book you were catching up on. Then the week after, it’s one more thing. Before you know it, your coffee table is cluttered with things. 

Like coffee tables, it’s easy for your medication regimen to slowly become cluttered over the years. Being on too many, or unnecessary, medications can be harmful to your health. Alice Brennan died because she was started on one inappropriate medication (a muscle relaxant called cyclobenzaprine) that caused side effects including confusion, falls, and loss of appetite. Unfortunately, her doctors didn’t recognize that the medicine was to blame. Instead, they added more medications to treat the side effects of the first one. 

Taking the time to focus on your medications, asking the right questions, and staying organized can all help make sure you are on the right medicines. 

It’s important to set aside some time and effort to do some “cleanup” of your medication list to make sure you are only on the medications that you need, and not those that are harming you. If you want to reduce the number of medications you are on, there are a few steps you can take to keep things tidy.

Tip 1: Make a medications list

One of the best ways to keep track of your medicines is the old fashioned way—pen and paper. Of course, you can use your phone, and can also ask for help—whatever works for you. Take stock of every medicine you take and make a list. Be sure to also include all over-the-counter medicines, as well as supplements. Write down the name, strength, how much or how many you are taking, and how often you are taking it. If it’s a prescription, write down who prescribed it for you.

As we age, we may see more medical specialists, and it’s important to keep one source of accurate information. If there are medications that were prescribed but you are not taking them, please also mark that down so you can let your doctor know. Once you have a comprehensive list of your medications, go through each medication on the list and write down next to it what you take it for. You may come across a medicine that you aren’t sure of why you take it. If that’s the case, then put a star next to that one for step 2! 

Tip 2: Talk to your primary care physician

Make an appointment with your primary care physician to review your medications. It often works best if this is its own appointment—if the appointment is about something else, you may run out of time to discuss your medications. You should do this at least once a year but should do it again if you have been in the hospital because your medications may have been changed, and your doctor may not even be aware. An accurate medication list is vital to your health and worthy of undivided attention!

As a conversation starter, try:

• “I would like to decrease the number of medicines I take. Which medicines do you think I could safely stop taking?”

If there were any medications that you marked with a star in Step 1, you can ask:

• “I am taking this medicine, but I don’t know what it is for. Can you help me understand what it is for? Do I still need it?”

Sometimes a medicine you are taking was prescribed for a problem you no longer have. Maybe that back pain that troubled you before doesn’t bother you so much after you did some physical therapy. Maybe your blood pressure no longer needs as tight control as when you were younger. Other questions to ask your doctor: 

• “This medicine was originally prescribed for XYZ. I don’t have that problem anymore; would I be able to stop taking it?” 
• “I have been on this medication for a long time. Do you think I still need it?” 
• “I have heard that as we get older it can be harmful to lower our blood pressure too much. What blood pressure level should I be aiming for based on my age and medical history?”
• “Do you think it would be safe to try cutting down this medication, and I could always restart it if I need to?”

While we hope all medicines have a positive impact on your health, sometimes the benefit is small. At the same time, all medications can have side effects. Remember that our bodies become more sensitive to drugs as we age, so we are more prone to those side effects, especially when you take a lot of different medications.

Taking a lot of medicine can cause other problems, too, such as difficulties keeping track of them. Sometimes these problems and side effects outweigh the benefits of the medication. There may be more effective and safer options for you that do not require taking medication. For example, improved diet and exercise may reduce the need for high blood pressure or cholesterol medications. Physical therapy can work wonders on chronic pain, so no more need for a muscle relaxer. Or seeing a counselor may help you get off a medication used for your mental health. You can ask your physician:

• “What would happen if I stopped taking this medication?” 
• “Are there alternatives to medications that I could do instead?” 

Hopefully, at the end of the visit you will have at least a few medications that can be “deprescribed.” This may mean that you can stop a medication entirely, or you may have to lower the dose slowly over time. If a specialist prescribes the medication for you, your primary care physician may want you to discuss this with your specialist prior to stopping the medicine. Sometimes, your PCP may suggest only stopping one medicine at a time.  

If you talk to your primary care physician but still have questions, consider reaching out to the pharmacist who dispenses your medication. They are well equipped to review everything you need to know about a medication you are taking. Simply asking “what should I know about this medicine?” or “should these medications be taken together?” can open up a great dialogue. Medication information pamphlets are shared each time a pharmacy dispenses a medication, and this can be a reliable source of information to read through as well. 

Tip 3: Keeping a medication off your list

If a medication is stopped or the dose is changed, make sure to put that on your list. That list will be the most reliable way to communicate your medications between different doctors, pharmacies, or hospitals. Otherwise, they may increase the dose again or restart the medication accidentally because they are unaware of the change.

Alice Brennan was prescribed cyclobenzaprine at a hospital but was told by her own doctor to never take it because it would be harmful. Tragically, she was given this drug again when she went back to the hospital for something else—because it was still on her hospital medication list. She died six weeks later due to side effects of this medicine. Having an updated list, with cyclobenzaprine marked as never to take, could have saved her life.

Clean up your medication list regularly with your physician. The goal is to keep it short and sweet—with only those medications that you need. 

You should know what every medicine is for, how it is helping you, and what side effects it may cause. If you think you are experiencing any of those unwanted side effects, speak up—your life may depend on it!

This is the third article in a series from Team Alice, a project of The Center For Successful Aging at the University at Buffalo. Please visit Team Alice’s YouTube page for more information on medication safety.

Funding for this research was provided by RRF Foundation for Aging Grant #2019060 and USDeN NIA R24AG064025 subaward STE2196-17.