Limit yourself to four medicines

Q. My mom is 91 years old. She is taking nine prescription medicines and three vitamins every day. Lately, she is often confused, dazed, and slow in moving. Could this be due to her medicines? Can you help us? — Marivic

A. From your questions, I am pretty certain one or several of her drugs are causing her symptoms. We can’t know for sure, so I would advise you to go back to your primary doctor and tell him about it. He will then slowly remove the drugs until he finds the culprit.

How Many Drugs Should I Take?

Doctors vary widely on how they treat their patients. Some doctors are aggressive and treat their patients by the book. This usually leads to multiple prescriptions and multiple medicines, sometimes reaching up to 14 medicines. Other doctors are more conservative and would like to try fewer medicines. From my own experience, I believe that most patients are better off with the more conservative approach.

When I was younger, I was bombarded with several medicines which left me dazed and confused. Although these medicines are helpful, right now I am still reaping the side effects of those medicines which really don’t go away.

More Drugs, More Side Effects

An elderly American doctor recently wrote that patients should try to limit their intake of medicines to only four. This is especially true for the elderly. More than four drugs would mean more side effects and make the patient prone to falls and fractures.

The first cardinal rule for doctors is to do no harm. If the patient can get well with fewer medications, then so be it. Here are the advantages of limiting yourself to four prescription drugs or less:

1. Less expense for the patient. Patients would save a lot of money, and money saved is money earned.

2. Better patient compliance. Since the patient will be taking fewer drugs, he can afford to buy more and take them daily. Also, four drugs are easier to remember as compared to 10.

3. Better self-esteem and confidence. There is nothing like taking a multitude of maintenance meds to make one feel impotent, sick, and like hanging on to dear life. With fewer drugs, patients are challenged to live and eat healthy. The patient now must strictly diet to lower his blood pressure, his cholesterol, blood sugar, and uric acid levels. In my experience, giving overweight patients high doses of medications will only make them complacent and eat more.

4. Less side effects. This is the most compelling advantage. The so-called “drug interaction” means that one drug may increase or decrease the effect of another drug when taken together. So just imagine 10 drugs mixing, interacting, and competing inside your body. Fewer drugs mean less side effects, especially for the elderly.

5. It’s gentler on your kidneys and liver. Drugs are usually excreted by the kidneys or liver. Multiple drugs may compete inside the same route of exit of the body. In short, there might be traffic and congestion, leading to overload and over dosage of the drug.

6. You don’t know what happens with more than four drugs. According to Dr. Clifton K. Meador, author of A Little Book of Doctors’ Rules, “There are very few studies on patients taking three drugs, and there are no controlled studies of patients taking more than four drugs. Any patient on more than four drugs is beyond medical science.”

What Dr. Meador means is that each drug, on its own, may be beneficial, but mix them all together and you don’t know for sure. It’s like we know that drinking milk is healthy. So are eating oranges and using olive oil. But if you mix all these healthy foods together, you might get an upset stomach.

7. In the elderly, all bets are off. The late Dr. Saturnino Ador-Dionisio, past president of the Philippine Heart Association, said, “If your patient is more than 80 years, he should be allowed to eat anything. How sure are you that your medicines will make him live much longer? They will just get mixed up.”

What About Supplements and Vitamins?

Aside from the four prescription drugs, I usually allow patients to take two supplements max. Choose your two most favorite supplements, say a multivitamin and calcium supplements.

Why only two? Because not all vitamins and supplements are harmless. Many of them are potent and have alarming side effects, too. My patient took too much ginkgo biloba and had spinal bleeding that required an operation. Another patient took two grams of vitamin C and had stomach bleeding, needing emergency blood transfusion. Be careful of what you put inside your mouth. See your doctor first.

Exceptions to the Rule

As a general rule, four medicines and two supplements can cure 98 percent of patients already. But of course, the very sick, very obese or very hard-headed may need to take more than four drugs.

But for the majority of us, let us try to take good care of our body so we can limit the amount of drugs we are taking. There is wisdom in this general rule, for doctors and patients alike.

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Medical wisdom

• Hippocrates: First of all, do no harm to the patient.

• Dr. William Osler: Imperative drugging — the ordering of medicine in any and every malady — is no longer regarded as the chief function of the doctor.

• Dr. Clifton K. Meador: The likelihood of an adverse drug reaction rises exponentially with any increase in the number of drugs administered. Use the smallest number of drugs possible. –Willie T. Ong, MD, Philippine Star

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For your questions, send e-mail to willietong@gmail.com.