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

8 comments on “Ten Drugs Doctors Should Consider De-Prescribing
  1. Lynn Lipke says:

    Interesting! Thank you. I am not on any of those, but I will share this with certain people I know that do take these.

  2. Colleen says:

    I am on a long acting supplement for asthma (Foradil), have tried ro get off of it without success but it is the asthma drug which gives me the most relief. Now the U.S. has blocked Canadadrugs.com from selling their drugs in the U.S. (cuf off is July 30). Foradil is manufactured in the UK and not available in this country as is my other Canadian purchased drug, Intal. My suspicion is that allergists will push their patients on stronger drugs with more serious side effects. I don’t know whether this means you could still drive over the border and bring the drugs back into this country or not. Would like to hear your response on this issue.

  3. Gina Pera says:

    Great list!

    I am constantly shocked at how many people with ADHD have been given benzos for “anxiety”. For chronic use. Instead of treated properly for ADHD+ anxiety/depression.

    It continues to amaze me how the neuro stimulants are vilified but the benzos and all these others are truly “handed out like candy,” as is accused of the stimulants.

    For people with ADHD, being properly treated can help them avoid most of the conditions you list above. That’s the irony.

  4. V. Corry says:

    Question re antibiotics before dental procedures: Does this pertain to those who have had hip or other replacements? My orthopedic surgeon and dentist are not in agreement about this. The former wants me to continue with the antibiotics; my dentist does not think it is necessary, but he acquiesces to the surgeon’s wishes.
    Comments, please.

  5. Gail Vescovi says:

    I am 65 yr old female on statins for years with no noticeable side effects. Every time I stop taking them my numbers (LDL especially & triglycerides) and inflammation numbers soar. There is heart disease in my family but no symptoms or illness for me yet. It is confounding to try to figure these things out, even with a general practitioner who is better with wellness issues than most. Also have a functional physician who has me on tons of supplements based on computer program readings which check out per my research, but still! Love your site and wish I lived closer & you took insurance!

  6. Dr E says:

    Dear V Corry
    This argument between dentists and orthopedists is nationwide. Personally, I don’t think antibiotics are necessary and the statistics seem to be confirming this. For my own hip replacement, when I went to see the dentist, I simply had forgotten about the antibiotics and didn’t take anything

  7. V. Corry says:

    Dr. E,
    Thanks so much for your input. I know that not all orthopedists are in agreement either; my sister had her hip replaced by a different doc and he did not advise her to take antibiotics before dental appointments.

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