Ten Drugs Doctors Should Consider De-Prescribing

Health Tips / 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.

Last year the online medical journal Medscape 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

4 thoughts on “Ten Drugs Doctors Should Consider De-Prescribing

    Fascinating. I was prescribed antibiotics to take for five days while getting dental implants. I decided that my immune system was super healthy and did not want to destroy my wonderful microbiome and did not take them. I got the worse infection of my life! I was a little embarrassed to tell the oral surgeon that I did not take them.

    Piper Crockett
    Posted December 10, 2019 at 3:54 pm

    This list is priceless. Two comments

    I have had a tooth pulled in preparation for an implant. Then the dentist called and wanted to put me on an antibiotic in preparation for the implant. I checked out the antibiotic on the internet and it said do not prescribe if the patient has a history of asthma, food or drug allergies. I have all three, have decided not to go ahead with the implant.

    Secondly, when my asthma worsened a few months ago, the allergist
    recommended going on a stronger drug which would put my vision at risk. Instead, I cut the amount of the drug I was already taking in half and added adrenal support once a day and my breathing is much improved

    Colleen Jersild
    Posted December 10, 2019 at 1:24 pm

    I have desperately tried to get off Prilosec. I have been on it for at least thirty years. I have tried substituting other less damaging medicines as substitutes. But nothing has worked and the resulting reflux pain leaves me paralyzed. I have severe food allergies though now most allergists tell me that the only true allergy is anaphylaxis. I don’t know what the truth is but I’ve been skin tested multiple times and my skin has strong reactions. Be that as it may, I cannot function without Prilosec which is distressing as I understand the problems it causes. Could you please respond to this.

    Barbara Greenman
    Posted December 10, 2019 at 8:19 am

      I was on nexium for probably 20 yrs. it was making me really sick including causing heart issues. I finally went to a naturopath because I didn’t know what else to do. She suggested apple cider vinegar 1tsp in a very small amount of water 10 minutes before each meal. Three days later I was no longer on nexium and I haven’t needed to go back. It’s been about seven 7 yrs. now. I take one tbsp in a very small amount of water before breakfast every morning and just once a day now and I am ready to take on the day no more stomach problems at all. Make sure the apple cider vinegar contains the “mother”.

      Posted December 10, 2019 at 1:13 pm

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