Are We Taking Some Medicines for Too Long?

From the WebMD Archives

July 17, 2015 -- At any given time, almost half of all Americans are using at least one prescription drug. That’s not to mention all the over-the-counter medications we take without a prescription.

We take a lot of medicine. But are we using some for too long?

In the long run, some medications can do more harm than good, and prolonged use can mask a larger problem. In some cases, changing your habits may ease the symptoms you’re using the medication for in the first place.

“There are always risks when you take any medicine. That includes over the counter and prescription medications,” says Jack Chou, MD, a family physician at Baldwin Park Medical Center in California. If you have a condition needing long-term treatment, though, the benefits may outweigh the risks.

Check with your doctor before you stop any medication he recommended. Don’t stop abruptly.

Short-Term Medications

Many meds are made to ease minor, temporary problems -- but taking them for too long may cause others. Talk to your doctor about your symptoms if you feel you should take an over-the-counter drug for longer than the time period on its label.

NSAIDs

Available both over the counter and in prescription strength, nonsteroidal anti-inflammatory drugs (NSAIDs) have long carried warnings about potential heart attack and stroke risks. Earlier this month, though, the FDA decided to strengthen warnings on those medications, which include ibuprofen and naproxen.

After looking at new safety information, the agency determined the risks are greater than first thought, and are seen even with short-term use and in people without a history of heart disease.

“The risk appears greater at higher doses,” according to the FDA. “Use the lowest effective amount for the shortest possible time.”

Talk to your doctor before you stop taking NSAIDs or if you feel you need them for an extended period, experts say. Ask why you’re taking the drug and if there are other options.

Benadryl and Other Anticholinergics

Over-the-counter diphenhydramine, found in Benadryl and some sleep aids, is an anticholinergic. So are some prescription antidepressants, bladder control medications, and drugs for Parkinson’s disease. A recent study found that taking any drug in this category for 3 years or more could raise your risk of getting dementia by more than 50%.

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“For younger people, for temporary use, it should be fine,” Chou says. “But there are potential problems with these, and we tend to avoid them in people who are over 65.”

If you’ve been taking one of these medications for more than a few years, it might be a good idea to ask your doctor whether you still need it, whether there are alternatives, and discuss the risks and benefits of stopping.

Proton Pump Inhibitors (PPIs)

These treat heartburn. People should only take over-the-counter forms for about 2 weeks, Chou says. If you still have repeated heartburn, you should see your doctor. “This is partly to make sure the over-the-counter PPI isn’t hiding something else,” he says.

Your doctor might rule out other issues and put you on a prescription PPI. “I have patients on long-term PPIs with no problems, but you do have to be aware of the potential risks,” Chou says.

PPIs can increase your chances of a hip break. They can lower your magnesium levels and cause shaking, cramps, and irregular heartbeat. They can raise the risk for pneumonia and a potentially serious intestinal infection called Clostridium difficile. A recent study suggested that people who take PPIs have a slightly higher risk of a heart attack. But the study couldn’t prove these drugs were the cause and didn’t show how much of the medication was too much.

Because of these risks, PPIs should be a last resort for heartburn. “The best place to start is by eliminating foods that might trigger the heartburn or by trying an H2 blocker,” says Macary Marciniak, PharmD, a professor at University of North Carolina’s Eshelman School of Pharmacy. H2 blockers, which work in a different way than PPIs, include over-the-counter drugs such as Pepcid and Tagamet.

The American Gastroenterological Society says you should only try a PPI if you have heartburn at least twice a week for several weeks and dietary changes and H2 blockers don’t work.

Sleeping Pills

Whether or not they are anticholinergics, prescription and over-the-counter sleeping pills are not for long-term, nightly use.

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“You can build up a tolerance to them and then the same dose will no longer be effective,” Chou says. This can make sleeping even harder.

Insomnia can also be a sign of another problem -- such as anxiety, depression, or sleep apnea -- that needs a different treatment. Another medication could cause the sleeplessness.

Your daily habits might also be the problem. Changing your habits can make it easier to get to sleep. For example, don't watch TV in bed, or avoid exercise too close to bed time. If you need a sleep aid for more than a few weeks, talk to your doctor about your insomnia.

Over-the-Counter Nasal Sprays and Oral Decongestants

Decongestant nasal sprays, such as Afrin, are for temporary congestion. You shouldn’t use them for longer than the timeframe on the label. “If you take it too long, it can actually make your congestion worse,” Marciniak says.

Taking decongestants containing pseudoephedrine by mouth long term can lead to other problems, including seizures, hallucinations, headaches, and insomnia.

If you have lingering congestion, talk to your doctor, because there are other ways to treat it.

Long-Term Medications

Some prescription meds treat conditions that could last a lifetime. If you have a prescription for any of the following medications, you might expect to take them for several years or for life.

Antidepressants

Expect to take an antidepressant for at least 6 months to a year for a first or second episode of depression. If you’ve had several bouts with the mood disorder, your doctor might suggest you take the prescription indefinitely.

Antidepressants have side effects, such as insomnia and less sexual desire, but the risk of side effects isn’t thought to go up for people who take the medications long term.

“Antidepressants in general are very safe for long-term use,” Chou says. “Sometimes not treating is more harmful, so if someone who’s severely depressed or has chronic recurrent depression needs antidepressants for the rest of their life, so be it.”

If you take these meds for years, you might get different or new side effects as you age, Chou says. That might be grounds for switching or talking to your doctor about tapering off the medication to help lower the potential for withdrawal symptoms.

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You can take extra steps to make your antidepressant work better for you. Exercise, good sleeping habits, and talk therapy can all help.

Antipsychotics

Depending on your condition, you may need antipsychotic medication for years, or for life. But some studies suggest that the people who benefit most from these drugs take them for only a few years.

The drugs prevent psychotic symptoms for the first few years, the studies say. But people who stay on them for a lifetime might have about the same risk of a relapse as people who stop after a couple of years. What’s more, people who stop might be more likely to get jobs and keep them. This suggests they are more likely to get back to a normal life after stopping the drugs.

Antipsychotics could also cause new side effects as you age. “As you get older, antipsychotics can cause confusion and increase risk of falls,” Chou says. As with antidepressants, doctors recommend that people taper off these drugs rather than suddenly stop.

But you should never stop taking antipsychotic medications without talking to your doctor.

Statins

For many people, the potential risks that statins bring do not outweigh the main benefit: prevention of heart disease. For instance, “We may need to reduce your risk or prevent a second heart attack,” Marciniak says.

In rare cases, statins can hurt your liver. You should call your doctor if you are unusually tired, have lost your appetite, or have right upper abdominal discomfort, dark urine, or yellowing of your skin or the whites of your eyes.

Some people who take statins say they had mild memory loss after starting the drug, but researchers say there is not enough evidence to support a connection between the two. Side effects such as muscle pain may also be common.

Statins could also slightly raise your risk for type 2 diabetes, but this doesn’t necessarily mean you should quit the medication.

“If you have a family history, maybe we need to monitor that more closely or try to find some alternatives,” Chou says. Your doctor might want to track your blood sugar after you start the drug.

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Albuterol

If you have asthma, this drug is the “rescue” medication you use during attacks. Many people with asthma also need a “controller” medication in addition to their rescue medication to prevent attacks over time.

The risks from albuterol come when you use it for more than just for attacks. If you find you need the medication more and more, you might need a prescription for a controller med or a larger dose of your controller medication.

“Using too much albuterol could make you feel jittery,” Marciniak says. “And it can make you have repeated episodes of not being able to breathe well.”

WebMD Health News Reviewed by Michael W. Smith, MD on July 17, 2015

Sources

SOURCES:

Macary Marciniak, PharmD, Director, Community Pharmacy Residency; Clinical Associate Professor, UNC Eshelman School of Pharmacy, Chapel Hill, N.C.

Jack Chou, M.D., Physician-in-charge, Baldwin Park Family Medicine, Baldwin Park, CA.

Family Doctor: “How to safely take antidepressants.”

Harvard Medical School: “Going off antidepressants.”

Sleep Foundation: “Depression and sleep.”

Recovery from Schizophrenia: “Does long term use of ‘antipsychotic’ result is more disability, and more psychosis?”

FDA: “Consumer updates: Statins.”

ABIM Foundation: “Treating heartburn and gerd.”

FDA: “FDA Drug Safety Podcast for Healthcare Professionals: Clostridium difficile-associated diarrhea can be associated with stomach acid drugs known as proton pump inhibitors (PPIs).”

Harvard Medical School: “Common anticholinergic drugs like Benadryl linked to increased dementia risk.”

Sleep Foundation: “Sleep aids and insomnia.”

Sleep Foundation: “What causes insomnia?”

Medscape: “Safe use of nasal decongestants.”

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