Duration of Drug Therapy

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.

The examples of omeprazole, zolpidem and alendronate

So, what do omeprazole, zolpidem, and alendronate have in common? They are examples of drugs that typically have a defined duration of use. Thus, they should not be continued beyond a certain timeframe unless your physician reassesses the appropriateness of doing so. Note that these are merely examples and not an exhaustive list of medications. In addition, there are situations where it may be appropriate to continue these medications for a longer duration. Finally, never stop taking a medication without first talking to your doctor or pharmacist.

Omeprazole (Prilosec®) decreases the production of acid in the stomach. It is in the drug class called proton pump inhibitors (PPIs). Geriatric experts recommend limiting PPIs to no more than 8 weeks’ duration when used to treat uncomplicated ulcers or gastroesophageal reflux disease (GERD).^1,2 Note that there are some exceptions where a PPI needs to be taken for longer than 8 weeks.
Zolpidem (Ambien®) is used to treat insomnia. It is in the drug class known as Z-drugs or non-benzodiazepine (non-BZD) drugs. Geriatric experts are cautious about using these drugs in older adults and recommend avoiding zolpidem and similar drugs whenever possible² or limiting use to no more than 2 weeks.¹
Alendronate is a drug to treat osteoporosis (a condition of weakened bones) and is in the drug class called bisphosphonates. Guidelines for treating osteoporosis recommend reevaluating the patient’s fracture risk after 3 to 5 years of taking alendronate or another bisphosphonate. A temporary stop, referred to as a “bisphosphonate holiday,” should be considered in patients who are at low or moderate fracture risk. In contrast, drug therapy should be continued or switched to a different medicine if the patient is at high risk of a fracture.³

Identifying medicines used beyond recommended duration

How can you know if any of your medications are intended to be used for a limited duration? The only way to know for sure is to ask your pharmacist or physician. Whenever a drug is started, ask about goals of the drug therapy and timeline for re-evaluating its effectiveness. This should provide information on whether the drug has a defined duration for use. Get a medication review annually or after being in the hospital. It’s okay to ask about medicines that may no longer be needed.

The importance of re-looking at medications that you’ve taken for a long time is not new. I recently came across an article from Consumer Reports, February 1992 (no kidding). It provided recommendations to consumers to make sure they are taking the right medications. One of them read: “If you’ve taken a drug for a long time, remind your doctor occasionally.” It may be time to stop certain medicines. Good advice 32 years ago and good advice now. Taking medications long after they are needed remains a common preventable medication-related problem.

By Hedva Barenholtz Levy, PharmD, BCPS, BCGP

10-21-24

This material is intended to encourage discussion with your health care provider. It is informational only and does not replace the guidance of your health care team.

References:

O'Mahony D, Cherubini A, Guiteras AR, et al. STOPP/START criteria for potentially inappropriate prescribing in older people: version 3 [published correction appears in Eur Geriatr Med. 2023 Aug;14(4):633. doi: 10.1007/s41999-023-00812-y]. Eur Geriatr Med. 2023;14(4):625-632. doi:10.1007/s41999-023-00777-y
By the 2023 American Geriatrics Society Beers Criteria® Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria® for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(7):2052-2081. doi:10.1111/jgs.18372
Management of osteoporosis in postmenopausal women: the 2021 position statement of The North American Menopause Society. Menopause. 2021;28(9):973-997. doi:10.1097/GME.0000000000001831