Does Medication Effectiveness Change Over Time?
Many older adults who have been on medications start noticing the prescription isn’t doing what it once did or may create sudden side effects
When Phyllis Robinson, 55, a Baltimore, Maryland resident, began experiencing GERD, more commonly known as acid reflux, about three years ago, she sought advice from her doctor and began taking an over-the-counter medication.
The medicine worked for about six months, but she suddenly noticed not only did the GERD return, but she started experiencing side effects with unpleasant symptoms such as anxiety (which she had never experienced) and severe muscle pain. "All my blood tests showed nothing, and doctors could not figure it out," recalls Robinson.
"I forgot to take my medication one day and noticed the pain was significantly better the next day."
Robinson was diagnosed with osteoarthritis and referred for eight weeks of physical therapy, which did nothing for her symptoms. "I forgot to take my medication one day and noticed the pain was significantly better the next day," says Robinson. "When I resumed the medication the next day, the pain came back, along with gas and bloating."
Robinson connected the dots and stopped her medication. She says she slowly improved each day until the pain was gone.
It's Not the Medication, But Our Bodies
"The medications aren't changing as we get older, but our physiology," says Dr. Marc Helzer of the University of Michigan Health- West Rockford in Grand Rapids, Michigan.
"If a person is on blood pressure medication for thirty years, for example, the response may change over time because as we grow older everyone experiences metabolic changes."
Dr. Robert Alesiani is also a board-certified geriatric pharmacist and chief pharmaceutical therapy officer for TabulaRasa Healthcare in Morristown, New Jersey. "If a person is on blood pressure medication for thirty years, for example, the response may change over time because as we grow older everyone experiences metabolic changes," says Alesiani.
He explains that most medications are in pill form, broken down by acid and enzymes in our stomach. Those acids and enzymes also change over time. Once the pill goes through the stomach, it passes through the liver and enters the bloodstream. At that point, depending on the medication, the liver will either then break it down, or the medication activates.
Factors such as PH levels, stomach content, other medications, age, weight, height, activity level and even stress level may affect medication absorption. Alesiani explains our kidneys, liver, and blood vessels change as we grow older, which affects how the body processes common medications many mature adults take.
Physiology Can Affect the Most Common Medications
Here are some of the most commonly prescribed medications for older adults and how changes in their bodies may affect the efficiency:
Factors such as PH levels, stomach content, other medications, age, weight, height, activity level and even stress level may affect medication absorption.
- Blood pressure and diabetes medications: Helzer says as we age and generally become more sedentary, we tend to need more blood pressure medications. Weight and other factors may also affect the required dosage.
- Blood thinners: When taking blood thinners for heart issues, people may try to eat leafy greens and grapefruit or drink certain juices to help improve their health. "Some vitamins don't interact well with these types of medications, so the dosage may need adjusting," says Helzer.
- Thyroid medications: According to Helzer, it's dependent on the type of thyroid malfunction being treated, but the effectiveness can certainly wane over time due to changes in the body.
- Diuretics: Helzer says some people take these for years without any changes, but as we grow older, and as kidney function decreases and the risk of dehydration increases, these may have to be reduced.
While many complain about doctors requiring their patients to visit 1-2 times yearly to check their blood, people must keep these appointments. "You may not think you're having a problem, but many of these changes in our bodies, and how the medication is interacting, are so slow you may not notice what a blood test may show," says Helzer.
"Your doctor should be monitoring your blood work and prescriptions closely for your own protection," he adds. Blood work can show subtle changes in kidney and liver function and magnesium deficiencies, sometimes caused by the continuous use of some antacids.
Helzer also doesn't recommend anyone stop taking their medication suddenly.
"Your doctor should be monitoring your blood work and prescriptions closely for your own protection."
As Alesiani explains, some medications, such as psychotherapy drugs, opioids and beta blockers, cause an over-stimulation of receptors in the bloodstream, and to get off the drug safely, patients must taper off slowly to stop the over-stimulation.
Answers Found Through Lifestyle Change
Muscle pain and spasms are a cause of magnesium deficiency, which is a side effect of some antacids. Robinson doesn't know if that caused her symptoms, but instead of changing medication, she tried a more holistic approach to her GERD problem.
For the past two years, she's changed her diet, eliminating all acidic food and drinks, eating healthier and drinking more water with mint added. Robinson also tried to sleep more and exercise. After spending over $1,000 out of pocket trying to figure out her problem with the medication, she says she now feels healthier.
"I haven't had a problem since, and I would just advise people to know how your body may change and not absorb medications as well," she says.