Dr. Peter Barkett
My patients ask me all sorts of questions, but one I commonly hear is Can I stop any of my medications? This is a great question to raise with a doctor because we are more often focused on prescribing medications than deprescribe They. All drugs can have benefits when selected for appropriate patients, and most prescriptions are well tolerated, but most also carry some risk of side effects. Doctors try to weigh the risks and benefits when prescribing.
Sometimes, when a patient’s situation, age, or health changes, so does the benefit-risk calculation for a drug. Therefore, it is also important to consider when a drug may no longer be needed or to find out if guidelines for regular use have changed. This includes some common over-the-counter medications that some people take on a regular basis. Your healthcare team should be consulted or notified when you intend to make a change as many medications should not be stopped abruptly or have benefits that may not be obvious (I feel better so maybe I don’t need this question anymore). It’s best to talk to your doctor about your specific situation and health before stopping most medications.
Here are some medications, both prescription and over the counter, it may be time to ask your healthcare team about them. (I will include the brand names to help readers recognize the drugs, but this information applies to generics and other brand names of these drugs.)
Antihistamines. These medications can be very helpful in reducing symptoms during allergy season, but most patients don’t need them indefinitely. First-generation antihistamines such as diphenhydramine (Benadryl) and hydroxyzine (Atarax) also have high rates of side effects such as dry mouth, dry eyes, constipation, difficulty urinating, and even confusion. Second-generation antihistamines such as loratadine, fexofenadine, and cetirizine (often known by the brand names Claritin, Allegra, and Zyrtec) are less likely to cause these side effects and may be good alternatives, particularly for more frequent use. But even second-generation products may not be needed for year-round use. If your symptoms are well controlled, it may be reasonable to switch to as-needed or seasonal use.
Heartburn medications. The medical term for heartburn is gastroesophageal reflux (GERD). It can be very uncomfortable, and fortunately, it’s limited for most people. There are two types of medications commonly used to treat symptoms, both of which are available over the counter without a prescription. Proton pump inhibitors (PPIs) include omeprazole (Prilosec) and pantoprazole (Protonix), and they work to reduce stomach acid. They work great for patients who experience frequent GERD symptoms that require daily treatment. However, some patients may no longer need it after weight loss or lifestyle changes help resolve their GERD. Keep in mind that there are some situations where stopping these medications would not be advisable, such as for patients with a history of stomach ulcers or where GERD has caused changes in the esophagus. The other class of drugs for GERD are H2 blockers and they include ranitidine (Zantac) and famotidine (Pepcid). They’re also available over-the-counter and can take effect faster than PPIs, so if your healthcare team approves a trial to stop other GERD medications, you have an option for quick relief on an as-needed basis if symptoms return.
Antibiotics before dental procedures. In the past, some patients have been recommended antibiotics to use before routine dental visits. This is rarely the recommendation yet; one case where it is recommended is for patients with mechanical heart valves. But that’s no longer the recommendation for most patients, including those with a history of joint replacement. This question has been studied by health researchers and the data speak for themselves. The American Academy of Orthopedics Surgery recommends against routine use of antibiotics before dental appointments in patients with joint replacements. Such use of antibiotics has not been shown to improve health outcomes. Overuse of antibiotics can risk side effects such as diarrhea or yeast infections, while also stimulating antibiotic resistance.
Aspirin. Many patients started taking aspirin years ago after its health benefits were discovered by reducing heart attacks and strokes. However, aspirin can increase your risk of bleeding and stomach ulcers. Therefore, the extent of benefit to each patient must be considered. People with a history of heart disease or stroke see the most benefit and generally shouldn’t stop taking aspirin. Patients without that history have an average risk of heart disease or stroke, so they get less benefit but the same amount of risk. On the other hand, statins may have more benefits with fewer risks and may be a better option for preventing a first heart attack or stroke.
Statins after age 74. I prescribe statins because they can have substantial benefits but carry relatively little risk. Statins such as rosuvastatin (Crestor) and atorvastatin (Lipitor) work to reduce cholesterol and reverse plaque buildup in the arteries. This reduces the chances of a heart attack or stroke by almost 50% at higher doses. The most common side effect of statins is muscle pain. If this occurs, it will clear up when treatment is discontinued, but will often resolve even with vitamin D replacement. The effect of statins on arteries and atherosclerotic disease is so significant that the benefits often persist for many years after use. discontinuation of treatment. This is why we can usually safely stop treatment in patients over the age of 74 who have no prior diagnosis of heart disease or stroke. These patients can cost for many years on the benefits they have already received from the previous use of the drug.
Sleep aids. Supplements like melatonin can help some people get back into sleep habits, but stronger sleeping pills like zolpidem (Ambien) and eszopiclone (Lunesta) can alter natural sleep patterns and become addictive over time. Fortunately, sleep is both a biological process and a habit that responds to lifestyle adjustments and consistent patterns. Patients who started taking a strong sleeping pill when the sleep pattern was disrupted often do not need to continue taking these drugs indefinitely. Working to improve sleep health can make prescriptions unnecessary, and it makes sense to try tapering them gradually with guidance from a healthcare professional.
Hormone replacement therapy. Oral estrogen therapy was once a popular way to manage menopausal symptoms. However, we now know that this carries significant risks, including heart disease, blood clots and some cancers. We also know that alternative medicines are often effective. Over time, the intensity of symptoms may also decrease. If you’ve been taking oral estrogen therapy for menopausal symptoms, you may want to consider working with your doctor to reduce or replace your hormone therapy.
Testosterone supplementation. The drop in testosterone levels in men is often not as sudden as the drop in estrogen during female menopause. Still many men experience symptoms and begin testosterone therapy. Testosterone can cause blood clots, elevated blood pressure, cardiovascular events, enlarged prostate, and sleep apnea. As with estrogen therapy, talk to your provider about other approaches or treatments for your situation.
This summer I’m traveling and I think it offers a good metaphor for thinking about drugs. When I travel, I hate leaving anything important at home, so I can tend to overpack. On the other hand, I really don’t like lugging a heavy bag around the airport, so while packing I try to ask myself: Truly do you have to bring this? There is a similar push and pull when it comes to drugs.
Prescription and over-the-counter drugs can improve health and well-being, but they also come with costs, inconvenience, and the possibility of side effects. Every person is different and has individual health needs and responses to medications. An individual’s situation will also evolve over time. Just like checking in regularly with wellness exams, regularly weighing the benefits of medications against possible risks helps keep you in the best health.
Peter Barkett, MD, practices internal medicine at Kaiser Permanente Silverdale. He lives in Bremerton.
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