Ten Drugs Doctors Should Consider De-Prescribing

Physicians use the word polypharmacy when a patient is taking five or more prescription drugs daily. A recent survey showed that half of women Medicare recipients were taking five or more drugs daily, and 12% of them were taking ten (!) or more.

New patients frequently arrive at WholeHealth Chicago carrying bags stuffed like piñatas with prescription drugs and nutritional supplements, the latter recommended by someone (online ad, health food store clerk) and never discontinued.

The online medical journal Medscape recently published a list of drugs doctors should strongly consider discontinuing in their patients. My first thought? “It’s about time.”

Here’s the list:

Antibiotics before dental procedures to prevent infection are frequently but misguidedly recommended. Both the ADA (American Dental Association) and the AAOS (American Academy of Orthopedic Surgeons) no longer encourage prophylactic antibiotics because there’s no evidence that doing so prevents much of anything.

Proton pump inhibitors (PPIs including Prilosec, Prevacid, Protonix, Dexilant) for long-term use. There are a handful of patients who do need daily PPIs–mainly those with severe reflux and elderly patients taking NSAIDs–but most do not. PPIs interfere with the absorption of calcium (increasing fracture risk), vitamin B-12, and thyroid and increase the risk of C. difficile  infection.

Statins for the primary prevention of heart disease. Here’s the title of one JAMA article that says it all: The Debate is Intense But the Data Are Weak. Statins are statistically useful in reducing heart risk in people with diabetes as well as preventing a second heart attack in someone who has already had one. But doctors are prescribing statins less frequently for people who have high cholesterol but no other risk factors. It’s also being recommended that statins not be prescribed to anyone over 75.

The “Z drugs” after age 65 need to be prescribed with care. These include the anti-anxiety benzodiazepine and the sleep meds zolpidem (Ambien), zaleplon (Sonata), temazepam (Restoril), and eszopiclone (Lunesta), as well as the numerous SSRI antidepressants. All are associated with mental confusion and increased falls with fractures.

Beta blockers (atenolol, propranolol, sotalol, etc.) were once high on the list for people who had had a heart attack, to improve what’s called long-term mortality, but recent research has not sustained this. For years beta blockers were a go-to med for high blood pressure, but again, they’re just not all that great compared to other meds available. Because the side effects outweigh the benefits, we’ll see fewer of these being prescribed.

Medications for asthma and chronic obstructive lung disease. Some people need inhalers, especially so-called rescue inhalers, during allergy season. But, interestingly, a recent study showed that among patients prescribed long-acting inhalers like Advair and Symbicort, many never had a confirmed diagnosis of asthma. The current recommendation is if a doctor suspects a patient has asthma, ensure the diagnosis is accurate by using spirometry testing (or a referral to a pulmonologist) before prescribing a lifetime of expensive inhalers.

Medications for urinary incontinence caused by bladder spasm (overactive bladder), including Vesicare, Ditropan, and Flomax, are effective for maybe 10% of patients and are discontinued because of side effects in 7%. They’re generally useless for everyone else.

The most commonly prescribed medication for Alzheimer’s, Aricept (donepezil), usually works for only one patient out of ten and in that instance for a relatively short time. Side effects are very common: nausea, lack of appetite, urinary incontinence, weight loss, and fainting.

Muscle relaxants for back pain (methocarbamol/Robaxin, cyclobenzaprine/Flexeril, carisprodol/Soma, and a dozen others) generally don’t work and cause side effects in most people (drowsiness, dry mouth). In my practice, I used to prescribe low doses of a time-release (once a day) version of cyclobenzaprine called Amrix, which is often effective for people with fibromyalgia. But the Big Pharma company that makes it knew it had an effective drug, got greedy, and bumped up the price to $1,100 for 30 capsules. Insurers are simply refusing to pay for it.

Lastly, you might be taking too many nutritional supplements of dubious value. People get their supplement recommendations from a variety of sources (including commercials) and the number of daily pills being swallowed keeps increasing. At WholeHealth Chicago, most of our supplement recommendations are for specific health issues and are not intended to be taken for the rest of your incarnation. If a supplement fails to deliver, you should stop taking it (let your practitioner know).

Some supplements are meant for long-term use, mainly to prevent illness (examples here are fish oil, D, an antioxidant combination, and turmeric) or a specific chronic health problem. If you need help trimming your list, ask your WHC practitioner.

Be well,
David Edelberg, MD

Posted in Blog, Digestion, Knowledge Base, Nutrition, Nutritional Supplements, Vitamins, & Herbal Remedies, Pain Management, Respiratory Health, T, Urinary Conditions Tagged with:
11 comments on “Ten Drugs Doctors Should Consider De-Prescribing
  1. Miriam Stein says:

    I wish you had offices in the North Shore !

  2. Maria Harris says:

    Hi!I’ve been diagnosed with Barrett’s Esophagus and have been resisting using a PPI, but my gastro doctor is insistent that I need it to prevent further damage and possible cancer.
    As a side note, I also have Hashimoto’s, EBV, MTHFR…and the list goes on. 🙂
    Do you recommend PPI usage for Barrett’s?
    Thank you!

  3. Irina McSweeney says:

    Totally agree with this. And as you said doctor- it’s about time!

  4. David Edelberg says:

    Hi Maria
    Barrett’s is one of the conditions where the PPI benefits definitely outweigh the risks, so follow your doctor’s advice

  5. Romanie Baines. says:

    Hello there, do you happen to know of any similar group to wholehealthchigago in Manhattan, NYC? I would be very grateful to find out about such an organization. I always agree with the articles in your blogs, but yet only seem to be able to find physicians in New York City who recommend the taking of various pharmaceuticals to me. I’m 75, in pretty good health and consistantly resist this advice to take drugs I believe that I don’t need! Many thanks.

  6. Dr. R says:

    Romainie. Here are two organizations that may be of assistance in finding a functional medicine physician in NYC. https://www.ifm.org/find-a-practitioner/ and http://acam.site-ym.com/search/custom.asp?id=1758 Good luck.

  7. Terri Albert says:

    What about Calcium and Vitamin D supplements for long-term use?

  8. Anne says:

    I have a Rx for atenolol from WHC for high blood pressure. What are the other better meds available I should be taking? Thx!

  9. Dr. R says:

    Terri. Calcium taken for bone health should be part of a bone healthy supplement product with other bone supporting nutrients. If necessary, this type of supplement can be used longer term. Vitamin D should be utilized when laboratory levels are low. Since sun exposure increases vitamin D in your body, you may require less during the summer. A low dose vitamin D supplement to maintain normal levels is appropriate. Have your PCP check vitamin D levels periodically.

  10. Dr E says:

    Hi Anne
    If the atenolol is working for whatever it’s been prescribed for (high blood pressure, migraine prevention, heart rhythm disturbances) and you’ve not had any side effects, just stick with it. The “de=prescribing” stance doesn’t mean to necessarily discontinue it but rather don’t use it as a first choice medication

  11. Maria says:

    Thank you so much for your response! You’ve given me such a measure of peace about this. It’s very much appreciated!

Leave a Comment