"Expert Advice You Can Trust Since 1995"
Senior Care Pharmacist Consulting in St. Louis

HbL Blog

Duration of Drug Therapy:  What do omeprazole, zolpidem, and alendronate have in common?

Use of unnecessary medications is one of 8 categories of medication-related problems that I describe in my book, “Maybe It’s Your Medications.” This article focuses on a specific aspect of unnecessary medication use, namely, duration of drug therapy. Continuing medications beyond a recommended or intended duration contributes to the risk of adverse drug reactions, interactions, unnecessary costs, and other more serious consequences associated with medication use.

Taking a medication “beyond the recommended duration,” where the duration is well-defined, has been identified as a signal of potentially inappropriate medication use among older adults.1  This means geriatric experts agree it is an important issue. Recommended duration can be a complex topic, though, and does not apply to every medication. When treating chronic health conditions, for example, medications typically are prescribed with the intent that the patient will take them ongoing for many years, until the patient’s condition or other circumstances change. Think about drugs to treat chronic conditions like high blood pressure, asthma, or rheumatoid arthritis, for example. In contrast, some medications have a well-defined duration of therapy, based on research or expert consensus, depending on the health condition being treated. While there is no specific list of these medications, it is important to recognize that duration of therapy is an important safety concept. In turn, individuals can feel comfortable to ask questions and start a conversation with their doctors.  

Read more: Duration of Drug Therapy

Brain Healthy Behaviors

In March 2023, I attended the American Society on Aging conference in Atlanta. Sanjay Gupta, MD was one of the keynote speakers, talking about his book, Keep Sharp. In addition, AARP was one of the sponsors at the meeting, and I came home with a neat postcard that summarized “6 Pillars of Brain Health.” These 6 pillars, along with videos about each one, are available on the AARP website. Here is a quick overview. These 6 Pillars are something we should all pay attention to, to keep our brains healthy as we age.

Read more: Brain Healthy Behaviors

A Day I’ll Always Remember:  St. Louis Pharmacist Publishes a Go-To Guide for Healthy Aging

As seen on Fox 2 NowI describe myself as kind of intense. I am very goal oriented. I want to get things done and get them done well. “Maybe It’s Your Medications” is now a published book. It has been my focus for quite some time. Finally, the hard work has paid off; it is published and available for purchase. My friends and colleagues know that this moment is the culmination of many years of focusing on a goal and working steadily to achieve it.

My experience in working with older adults in their homes to review and evaluate drug therapy—touching hundreds if not thousands of patients and family members over the years—has informed me of the many types of errors and issues that can occur. This includes issues surrounding the use of both prescription and nonprescription medications.

Read more: A Day I’ll Always Remember: St. Louis Pharmacist Publishes a Go-To Guide for Healthy Aging

Advocating for Safe Medication Use 

I had the honor in June 2023 to speak to caregivers on the topic of Advocating for Safe Medication Use, courtesy Aging Advantage in St. Louis, as part of their Family Caregiver Education program. The program was livestreamed on Facebook (the first time I’ve done something like that!), and you can access the full recording here.

Per Merriam-Webster, to advocate means “to support or argue for” a cause or policy, for example. In this case, the cause is safe medication use for yourself or a loved one. Why is this an important topic?

Read more: Advocating for Safe Medication Use

PrevenTable: A PreventEd Podcast

"Do you have any questions for the pharmacist?"

PrevenTableMay 2022

Dr. Hedva Barenholtz Levy explains her role as a geriatric specialist pharmacist and the complexities that accompany working with older adults. Listen as she describes the risks that alcohol, cannabis, and opioids can pose to seniors and as she urges consumers to become an active part of their healthcare team.

Read more: PreventEd Podcast "Do you have any questions for the pharmacist?"

Medications for Alzheimer’s, Urinary Incontinence, and the Prescribing Cascade

Medications commonly used to treat Alzheimer’s Disease (AD), from a drug class known as the “cholinesterase inhibitors,” also can increase the risk of developing urinary incontinence (referred to as overactive bladder). There are three cholinesterase inhibitors available in the US:

  • donepezil (Aricept®)
  • galantamine (Razadyne ®)
  • rivastigmine (Exelon®)

This adverse drug effect of cholinesterase inhibitors became well-documented after the medications were approved and more widely prescribed. It is important to be aware of and recognize this potential effect because it often leads to the addition of another medication to control the incontinence. Adding a drug to manage the side effects of another drug is referred to as a “prescribing cascade” and is one of the several causes of polypharmacy.

Read more: Medications for Alzheimer’s, Urinary Incontinence, and the Prescribing Cascade

Be Aware of Brand Name Extensions:  All Zantac is Not the Same 

The other night I saw a television advertisement that caught my eye. It was for a heartburn product, “Zantac 3600.” It drew my attention because Zantac is the brand name for the generic drug ranitidine, which was withdrawn from the market in April 2020 because of contamination concerns. The easy work-around when ranitidine was withdrawn was to switch to famotidine (brand name Pepcid). Ranitidine and famotidine are in the same drug class of “H2-receptor antagonists.” They are comparable agents and both are available as over-the-counter (OTC) products for treating heartburn. It was an easy substitution. 

In late April 2021, however, the manufacturer of Zantac introduced a new product, Zantac 3600, to the market The catch is that this new Zantac product contains famotidine, not ranitidine. Adjusting the name from Zantac to Zantac 3600 is an example of what is called “brand name extension.” It is a marketing tool commonly used by manufacturers of OTC products to capitalize on consumer familiarity with brand names. Unfortunately, brand name extensions can be misleading to the unassuming consumer.

Read more: Be Aware of Brand Name Extensions: All Zantac is Not the Same

Medication Adherence in Older Adults is Not So Simple

Medication adherence, defined as the degree to which a person follows medication instructions, is a challenge for older adults. Indeed, it is estimated that about 50% of older adults are not fully adherent with their medications. The reasons are multifold, however, and not simply a matter of remembering to take a pill. Poor medication adherence among adults age 65 and older results from complex drug regimens plus numerous individual variables.

Read more: Medication Adherence in Older Adults is Not So Simple

It Is Never Too Late to Quit Smoking

Smoking increases the risk for heart disease and heart-related death.  Quitting smoking is known to reduce these risks.  However, the impact of quitting smoking on older adults has not been well-studied.  Does quitting smoking after the age of 60 make a difference? 

The answer is yes.  A study looked at over 500,000 smokers and nonsmokers aged 60 and older, to evaluate the impact of smoking and quitting smoking on heart-related outcomes specifically in this age group.  The 3 major heart-related outcomes were evaluated:  (1) cardiovascular deaths, (2) acute coronary events (defined as heart attack, unstable angina, or coronary death), and (3) stroke.

Read more: It Is Never Too Late to Quit Smoking