AboutMary E Scott, RPh, CGP Expertise I am a certified geriatric pharmacist with over 23 years experience as a long-term care consultant to nursing homes. I also do community-based consulting on an individual basis. My facility-based monthly newsletter on pharmacy topics is read by nurses in over 200 long-term care facilities in 5 states.
Experience I received a BS in Pharmacy in 1980 with post-graduate work in public health. I have had a Consultant Pharmacist license since 1984.
Organizations American Society of Consultant Pharmacists .I received certification in geriatric pharmacy in 1998.
Question My Mom has been placed on so much medication, aged 84. She seems drugged and not too coherent anymore and I want to find a gerentologist but have to get a permission letter from physician first. I would like to have as much info. as possible to see if there is a need. Following is a list of all medications.
CLONAZEPAM 0.5 AM/PM
ATTENOLOL 25 MG. AM ONLY
OXBUTYNIN 5 MG. 1 AM 1 NOON 2 BEDTIME
MIRTAZAPINE 30 MG. PM
PREDNISONE 5MG. AM ONLY
LOTREL 2.5-10MG. PM
RANITIDINE 150 MG. AM/PM
TEMAZEPAM 30 MG. AT BEDTIME
NON-PRESCRIPTION
BAYER 81MG AM
CALCIUM 600 MG. PM
TYLENOL EXTRA STRENGTH 500 MG. 4 PER DAY
DULCOLAX 2 AT BEDTIME
DOES THIS SEEM LIKE TOO MUCH MEDICATION TO YOU? tHANKS FOR YOUR HELP. JD HALE
Answer Hi, JD!
Sorry it took so long for me to answer; the All experts website was down for repairs the last few days.
I see problems with some of her medications. Given her age, there are one or two meds that she should not be on.
I can give you my opinion,but since I don't know her medical history, any suggestions I have should be discussed with her physician before taking her off anything or changing her medication in any way.
The first thing that jumped out at me was that she is taking too high of a dose of Restoril (temazepam). The recommended dose for anyone over 65 is 7.5mg at bedtime, and it should not be taken continuously(greater than 10 days). Continuous use of a hypnotic for sleep can cause cognition problems,especially if taken with other mood-altering meds such as the clonazepam.
Another medication that can affect cognition is the oxybutynin for incontinence. This med has anticholinergic properties which can also affect vision,cause drowsiness,which can lead to falls and fractures. If she needs a med to decrease bladder incontinence, ask her doctor if she can be switched to a timed-release med of the oxybutynin,it is more expensive,but causes much less dangerous side-effects,and is only taken once daily.
The other med I would question is the ranitidine. If she is taking it for heartburn,the dose could be decreased to 150mg at bedtime as a maintanence dose. In the higher dose,it also has anticholinergic effects and may be contributing to the confusion.If she is taking it for GI bleed, she may be able to be switched to a Proton-pump inhibitor such as Prilosec,Nexium,etc
I don't see a problem with her non-prescription meds. Just a caution,though-make sure she doesn't take more than 4 grams of Tylenol (acetaminophen)daily. That would be more that 8 of the Tylenol extra-strength. The elderly do not metabolize acetaminophen as well, and it can accumulate in the liver.
I hesitate to say anything about the clonazepam,since I don't know whether she is taking this for seizures,pain,anxiety,or some other reason. Clonazepam is a long-acting benzodiazepine,and this class of drugs is not usually recommended for use in the elderly as an anti-anxiety medication,but if she is taking it for another reason, that should be clarified with her doctor.
I commend you on taking the initiative to make sure your mother's meds are appropriate for her. I hope my comments have helped and feel free to email me again for clarification or just an update on how she is doing. Mary
