Nearly half of people who take certain types of prescription drugs continue taking them for longer than is recommended or safe, according to a study of more than 50,000 adults published today in the journal Annals of Family Medicine.
Researchers looked at how long a set of Canadian patients took antidepressants; proton-pump inhibitors (PPIs), used to treat heartburn and stomach acid issues; and bisphosphonates, used to treat osteoporosis and to prevent the loss of bone density.
These medications are not meant to be taken indefinitely and are generally only recommended for a certain period of time. Yet the study authors found that about 43 percent of people with these prescriptions were on them for significantly longer than is recommended.
When these and other drugs are taken for too long, they can become less effective, less useful, and more likely to cause serious side effects. Even more harmful, the study authors write, having too many prescriptions makes it more likely that people will end up on medications that have dangerous interactions with other drugs they're taking.
In many ways, it's a systematic problem, says Dee Mangin, a family physician and a professor of family medicine at McMaster University and the University of Otago and lead author of the new study.
"Our whole medical system is geared to starting things, but completely invisible in the prescribing system is a setup for stopping things," she says. "For many drugs, the original reasons for taking them become lost in the mist of time."
When a Prescription Lasts Too Long
Mangin and her colleagues chose these three categories of drugs because they represent a wide range of popular prescriptions.
The goal was to provide a snapshot of how common it is for people to receive any sort of prescription that was continued for too long.
What they found surprised them.
When patients were prescribed antidepressants, 46 percent of them were prescribed for longer than 15 months—nine months longer than the most common recommendation. Forty-five percent of people prescribed proton pump inhibitors for stomach acid were prescribed those drugs for longer than 15 months, though these drugs usually shouldn't be taken longer than 3 months. And 14 percent of people prescribed bisphosphonates for bone health had prescriptions that lasted at least six months longer than the five years normally recommended.
The study authors wrote that they picked these time frames to make sure they showed cases in which drugs were prescribed significantly longer than they were recommended for, and not just borderline cases or scenarios where a person was tapering off a medication.
There are some cases where you'd expect doctors to have good reason to decide to continue a prescription longer than normally recommended, according to Robert M. Breslow, RPh, an associate professor at the UW-Madison School of Pharmacy, who was not involved in the study.
But this decision, which the study authors refer to as "legacy prescribing," should only happen in a small proportion of cases, according to Mangin. "The rates we found were in excess of what we might expect," she says.
Doctors who start someone on a prescription for a good reason may later renew it without a full assessment of whether or not it's still needed, says Nitin S. Damle, M.D., past president of the American College of Physicians and a physician in private practice in Rhode Island, who was not involved in the study.
"If there's no follow-up and [patients'] prescriptions are just renewed electronically, there's very little thought as to whether they need to be on it or not," he says.
The Risk of Indefinite Prescription Drug Use
One of the biggest potential dangers of continuing a prescription for too long is that every ongoing prescription increases the chances of drugs interacting and causing a harmful reaction.
"The more medications you give someone, the more likely it's going to result in a negative interaction," Breslow says.
Having too many prescriptions is also an expensive and confusing burden that patients have a hard time keeping up with, according to Mangin. People might take a drug too frequently or miss doses of an important medication, both of which can lead to dangerous side effects.
In some cases, the side effects from drugs get worse if they're continued for too long.
Proton-pump inhibitors are usually meant to be taken intermittently or for a few weeks, and most people who take them could probably get relief from a less potent drug instead. If taken for too long, they can have rare but serious side effects, including lowering magnesium levels, damaging the kidneys, and increasing the risk for osteoporosis and dementia.
But at certain times, experts say, this increased risk may be worth it. For example: If a person is suffering from gastroesophageal reflux disease (GERD), which can lead to esophageal cancer, the extra risk of a PPI may well be worth the extra protection it offers.
"We have to deal with each patient as an individual and really assess them in a holistic way in terms of risk and benefit," Breslow says.
Is It Time to Stop One of Your Meds?
Doctors and pharmacists bear much of the responsibility for making sure that patients aren't taking drugs for too long. These professionals should ensure that medications are only prescribed for as long as they're needed and should regularly review the medications a patient is taking, according to Damle.
But consumers can also help by initiating these conversations if your provider does not. Start with these tips:
- Once a year, bring all the drugs you are taking in to your doctor's office. That way your doctor can check and see if all of those medications are still needed or if you have multiple prescriptions targeting the same symptom. This is especially important if you have prescriptions from multiple doctors, says Breslow, such as a cardiologist and a primary care internist.
- Talk to your doctor about eliminating certain medications or lowering your dose. Anyone taking multiple medications should have a conversation with their doctor each year to see if there are medications they can stop, Mangin says. Ask if you can try a lower dose or take a medication only as needed, she says. Older adults often need a lower dose of drug in the first place. (Check out this guide to some questions you should ask every time you get a new prescription.)
- Don't stop taking a medication without having a conversation with your physician. Stopping some medications too quickly can be dangerous. For some drugs, like antidepressants, people often need to taper off, gradually reducing their dose under a doctor's supervision, according to Breslow.
- If you visit different pharmacies, bring them an up-to-date list of everything you are taking. Every pharmacy has an "interactions module," according to Breslow, which can flag drugs that will cause potentially harmful reactions when taken along with other medications. But if you visit different pharmacies to pick up prescriptions, they don't automatically have everything you are taking in their systems.
- Don't forget to tell your doctor about over-the-counter drugs and supplements. Over-the-counter drugs and dietary supplements can also cause reactions when taken alongside other medication, says Breslow. When talking to your doctor and your pharmacist, they need to know everything you are taking, even if you think it's harmless.
- If your prescriptions are renewed electronically or automatically, ask for a consult to make sure you need to continue taking them. Automatic renewal can be a problem for the drugs mentioned in the new study, including antidepressants, PPIs, and bisphosphonates. Doctors say to also be cautious about extended use of pain medication, anxiety medication, muscle relaxers, decongestants, and sleep aids.
