Older Adults

Most of the time, medicines  make our lives better. They reduce aches and pains, fight infections,  and control problems such as high blood pressure or diabetes. But  medicines can also cause unwanted reactions.

One problem is interactions, which may occur between

• Two drugs, such as aspirin and blood thinners
• Drugs and food, such as statins and grapefruit
• Drugs and supplements, such as ginkgo and blood thinners
• Drugs and diseases, such as aspirin and peptic ulcers

Interactions can change the actions of one or both drugs.   The drugs might not work, or you could get side effects.

Side effects are unwanted effects caused by the drugs.  Most are  mild, such as a stomach aches or drowsiness, and go away after you stop  taking the drug.  Others can be more serious.

Drug allergies are another type of reaction.  They can be mild or  life-threatening.  Skin reactions, such as hives and rashes, are the  most common type. Anaphylaxis, a serious allergic reaction, is more rare.

When you start a new prescription or over-the-counter medication, make sure you understand how to take it correctly.  Know which other medications and foods you need to avoid. Ask your health care provider or pharmacist if you have questions. 

According to Today's Geriatric Medicine:   Warfarin (Coumadin) is a blood-thinning medication that  helps treat  and prevent blood clots. Eating certain foods, especially those  rich in  vitamin K, can diminish warfarin’s effectiveness. The highest   concentrations of vitamin K are found in green leafy vegetables such as  kale,  collards, spinach, turnip greens, Brussels sprouts, broccoli,  scallions,  asparagus, and endive.

“It’s not that patients should avoid foods that contain   vitamin K,” advises Zive. “Rather, they should keep their intake  consistent  from day to day.”

He describes a scenario that could spell trouble for an   older adult: “If a doctor tells a patient that they should lose weight  and  they, in turn, start to eat more greens, their vitamin K intake  will go up, and  this will counteract the anticlotting action of  warfarin.” 

According to Today's Geriatric Medicine:    An alcoholic drink can increase or prolong the effects of  insulin or  oral diabetic agents (pills) and thus lead to hypoglycemia or low   blood sugar. The glucose-lowering action of alcohol can last as long as  eight  to 12 hours. Symptoms of hypoglycemia include nervousness,  sweating, trembling,  intense hunger, weakness, palpitations, confusion,  drowsiness, and ultimately  coma.

With a doctor’s approval, and in the absence of other  health  conditions such as pancreatitis, elevated triglycerides, and  neuropathy, older  adults with diabetes may be able to enjoy up to two  drinks per day. A drink is  defined by the American Diabetes Association  as a 12-ounce beer, a 5-ounce  glass of wine, or 1.5 ounces of a  distilled beverage such as whiskey, vodka, or  gin. Individuals can  reduce the risk of low blood sugar by having alcoholic  drinks at  mealtime or by having a snack along with the drink.
 

In addition, certain oral diabetic medications such  as  chlorpropamide (Diabinese) can cause dizziness, flushing, and  nausea when taken  along with alcohol.

According to Today's Geriatric Medicine:   Digoxin (Digitalis, Digitek, Lanoxin) is used to strengthen  the  contraction of the heart muscle, slow the heart rate, and promote the   elimination of fluid from body tissues.
 

Dietary fiber, specifically insoluble fiber such as  wheat  bran, can slow down the absorption of digoxin and lessen its  effectiveness. To  prevent this, elders should take digoxin at least one  hour before or two hours  after eating a meal.

Herb use can also affect digoxin. For example, ginseng  can  elevate blood levels of digoxin by as much as 75%, while St. John’s  Wort  decreases blood levels of this drug by 25%.

“It’s important for the patient to recognize signs of  digoxin  toxicity,” says Zive. “These include a yellow tint to vision  and the appearance  of halos around objects, as well as weakness,  confusion, dizziness, and nausea  and vomiting.”

According to Today's Geriatric Medicine:    Statins are highly effective cholesterol-lowering drugs.   Unfortunately, says Zive, “Drinking grapefruit juice or eating fresh  grapefruit  can increase the amount of some statins in your blood and  lead to potentially  greater side effects of these drugs.”  Side effects of statins include muscle soreness and liver   abnormalities reflected in high transaminase levels (serum  glutamic-oxaloacetic  transaminase and serum glutamic pyruvic  transaminase) on a blood test.  This interaction is especially strong with simvastatin   (Zocor) and lovastatin (Altoprev), milder with atorvastatin (Lipitor),  and  nonexistent for pravastatin (Pravachol), so it’s important for  elders to check  whether their prescribed statin drugs do interact  before giving up vitamin  C-rich grapefruit.

According to Today's Geriatric Medicine:  Calcium channel blockers are prescribed for high blood  pressure. A  natural element found in grapefruit latches onto the intestinal  enzyme  called CYP3A4, which alters the breakdown of the calcium channel   blockers, possibly resulting in excessively high blood levels of the  drug,  along with an increased risk of serious side effects. 

It doesn’t take a jumbo serving of grapefruit to produce a   deleterious effect either. For example, a single 6-ounce glass of  juice can  reduce levels of CYP3A4 by nearly 50%. This effect dissipates  slowly. One study  indicated that one third of the impact on CYP3A4  from grapefruit juice was  still evident a full 24 hours later.

The interaction between grapefruit and calcium channel   blockers is strongest, for example, with felodipine (Plendil),  nicardipine  (Cardene), and nisoldipine (Sular) and weaker with  amlodipine (Norvasc),  diltiazem (Cardizem), and nifedipine (Adalat).
 

 Tangelos, a cross between a tangerine and  grapefruitlike  pomelo and Seville oranges, a bitter citrus fruit used  to make marmalades, can  have the same deleterious effects as grapefruit  on both statins and calcium  channel blockers.

According to Today's Geriatric Medicine:   Although unproven, evidence points to the likely fact that  grapefruit  juice gives a boost to blood levels of erectile dysfunction drugs  such  as sildenafil (Viagra). This may seem like a boon to some men, but it   could trigger headaches symptomatic of fatal or near fatal conditions,   flushing, or low blood pressure. 

According to Today's Geriatric Medicine:    The over-the-counter pain reliever acetaminophen (Tylenol)  and alcohol don’t mix.  “Two or more alcoholic drinks per day can increase the  liver  toxicity of Tylenol,” says Zive. “This toxicity can happen even  if a patient  takes less than the maximum 4 grams, or eight tablets, of  Tylenol per day.”

This interaction can be especially problematic in older adults, since the liver’s ability to diminish drugs decreases  with  age. “The liver of a 65 year old doesn’t function the same way it  did at age  25,” he says.

According to Today's Geriatric Medicine:   Dairy products such as milk, yogurt, and cheese can delay or  prevent  the absorption of antibiotics such as tetracyclines and ciprofloxacin   (Cipro). This occurs because the calcium in such foods binds to the  antibiotics  in the stomach and upper small intestine to form an  insoluble compound.  To avoid problems, Zive recommends taking an antibiotic one  hour before or two hours after a meal.

However, there’s no need to avoid milk and dairy with all   antibiotics. For example, it’s recommended that metronidazole (Flagyl)  should  be taken with water or milk to prevent stomach upset.

According to Today's Geriatric Medicine:  Monoamine oxidase inhibitors are an older type of  antidepressant  still prescribed, albeit less frequently, due to their serious  side  effects.  “Foods containing tyramines, such as some red wines, malt beer, smoked fish, aged cheeses, and dried fruits, can cause a  hypertensive  crisis or severe and dangerous elevation in blood pressure  when taken with this  class of antidepressants

According to Today's Geriatric Medicine:  Antithyroid drugs are compounds that interfere with the  body’s  production of thyroid hormones, thereby reducing the symptoms of   hyperthyroidism. According to a broad body of research, Americans’  high-iodine  diets account for the lower remission rate of  hyperthyroidism in those who are  prescribed antithyroid drugs.  Antithyroid drugs work by preventing iodine absorption in   the stomach. A high-iodine diet requires higher doses of antithyroid  drugs. The  higher the dose of antithyroid drugs, the greater the  incidence of side effects  that include rashes, hives, and liver  disease.  The richest dietary sources of iodine are seafood  and  seaweed, such as kelp and nori. Iodine is also found in iodized  salt and to a  lesser extent in eggs, meat, and dairy products. 

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• Abuse      see Elder Abuse 
• Accidents      see Falls 
• Age-Related      Macular Degeneration see Macular Degeneration 
• Ageusia      see Taste and Smell Disorders 
• Aging      see Older Adult Health 
• Aging      Skin see Skin Aging 
• Alzheimer's Caregivers 
• Alzheimer's Disease 
• AMD      see Macular Degeneration 
• Amnesia      see Memory 
• Angina 
• Anosmia      see Taste and Smell Disorders 
• Arteriosclerosis,      Coronary see Coronary Artery Disease 
• Artificial      Lens see Cataract 
• Assisted Living 
• Assistive Devices 
• Atherosclerosis,      Coronary see Coronary Artery Disease 
• Balance Problems 
• Bladder      Control see Urinary Incontinence 
• Blood      Pressure see High Blood Pressure 
• Bone      Loss see Osteoporosis 
• Brain      Attack see Stroke 

• CAD      see Coronary Artery Disease 
• Cardiac      Diseases see Heart Diseases 
• Cardiac      Failure see Heart Failure 
• Cardiovascular      Diseases see Heart Diseases 
• Caregivers      for Alzheimer's Disease see Alzheimer's Caregivers 
• Cataract 
• Cerebrovascular      Disease see Stroke 
• Change      of Life see Menopause 
• CHF      see Heart Failure 
• Chronic      Obstructive Pulmonary Disease see COPD 
• Congestive      Heart Failure see Heart      Failure 
• COPD 
• Coronary      Arteriosclerosis see Coronary Artery Disease 
• Coronary Artery Disease 
• CVA      see Stroke 
• Day      Care see Home Care Services 
• Deafness      see Hearing Disorders and Deafness 
• Degenerative      Joint Disease see Osteoarthritis 
• Dementia 
• Diabetes 
• Diabetes      Mellitus see Diabetes 
• Dysgeusia      see Taste and Smell Disorders 
• Dysosmia      see Taste and Smell Disorders 
• Elder      Abuse 
• Emotional      Health see Older Adult Health 
• Erectile Dysfunction 
• Essential      Tremor see Tremor 
• Exercise for Older Adults 

• Falls 
• Fitness      see Exercise for Older Adults 
• Glaucoma 
• Healthy      Aging 
• Hearing Disorders and Deafness 
• Heart      Diseases 
• Heart      Failure 
• Herpes      Zoster see Shingles 
• High Blood Pressure 
• Home Care Services 
• Hot      Flashes see Menopause 
• Hypertension      see High Blood Pressure 
• Impotence      see Erectile Dysfunction 
• In-home      Care see Home Care Services 
• Incontinence      see Urinary Incontinence 
• Insurance      see Medicare 
• Intraocular      Lens see Cataract 
• Liver      Spots see Skin Aging 
• Long-Term      Care see Assisted Living; Nursing      Homes 
• Macular Degeneration 
• MCI      see Mild Cognitive Impairment 
• Medicare 
• Medicare Prescription Drug Coverage 
• Memory 
• Menopause 
• Mental      Health, Older Adults see Older Adult Mental Health
• Mild Cognitive Impairment 
• Nursing      Homes 
• Nutrition for Older Adults 
• Older Adult Health 
• Older Adult Mental Health
• Osteoarthritis 
• Osteoporosis 
• Paralysis      Agitans see Parkinson's Disease 
• Parkinson's Disease 
• Perimenopause      see Menopause 
• Post-herpetic      Neuralgia see Shingles 
• Premature      Menopause see Menopause 
• Presbycusis      see Hearing Disorders and Deafness 
• Prostate Cancer 
• Prostate Diseases 
• Residential      Care see Assisted Living 

• Senility      see Dementia 
• Seniors'      Fitness see Exercise for Older Adults 
• Seniors'      Mental Health see Older Adult Mental Health
• Seniors'      Nutrition see Nutrition for Older Adults 
• Shaking      Palsy see Parkinson's Disease 
• Shingles 
• Sinus      Infection see Sinusitis 
• Sinusitis 
• Skin      Aging 
• Smelling      Disorders see Taste and Smell Disorders 
• Stress      Incontinence see Urinary Incontinence 
• Stroke 
• Sugar      Diabetes see Diabetes 
• Syndrome      X (Cardiac) see Angina 
• Taste and Smell Disorders 
• Tremor 
• Urinary Incontinence 
• Violence      see Elder Abuse 
• Wrinkles      see Skin Aging