Use With Caution: 4 OTC Medication That Seniors Should Avoid

The amount of drugs people take, be they over-the-counter (OTC) or physician-prescribed, tends to grow with age, and consequently, the odds of taking a potentially inappropriate medication (PIM) increase as well.

According to HealthinAging.org, “one in six adults age 65 or older will likely have one or more harmful reactions to a medication or medications.”

Guidance on OTC medications for seniors is currently provided by the Beers List, which was developed in 1991 by Mark Beers and a panel of experts. AGS Beers Criteria® identifies medications with risks that may exceed their benefits using “explicit criteria for potentially inappropriate use of medications in nursing home residents.”

The Beers List of PIMs, updated in 1997, 2003, and 2019 to include new medications and evidence, details drugs with little proven efficacy, with superior available alternatives, and with a poor risk-benefit ratio for seniors.

OTC PIMs are often used by the elderly, but they can cause adverse reactions. Let’s take a look at the most common.

Diphenhydramine

Sold under the brand name Benadryl, this was the original antihistamine before newer versions were introduced. Benadryl is used to relieve allergy symptoms and off-label to induce sleep.

Newer antihistamines, including fexofenadine (Allegra), loratadine (Claridine), and cetirizine (Zyrtec), are as effective as Benadryl but don’t make you sleepy.

Many older adults use Benadryl to help them sleep; however, only two short-term studies have investigated the efficacy of Benadryl as a sleep agent. The sleep-inducing qualities of Benadryl only last for a few days, and tolerance builds quickly, so more of the drug is needed to get the same sleep-inducing effect. Moreover, Benadryl can interfere with cognition and cause cognitive decline in seniors.

Benadryl is classified as a high-severity PIM on the Beers List when used as a sleep agent, and so it should not be used as a sleep aid, even for a short time.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Pain increases with age, and many seniors use NSAIDs like ibuprofen to manage it. Unfortunately, chronic ingestion of NSAIDs has been linked to these conditions:

• Diarrhea, gastrointestinal problems, and internal bleeding
• Heart attack and heart failure
• High blood pressure
• Kidney damage and liver toxicity
• Low sodium
• Nausea and upset stomach
• Stroke
• Ulcers

To reduce the potential for adverse reactions, the Beers List recommends using the lowest effective NSAID dose for the shortest possible time.

Ferrous Sulfate

This OTC medicine, used to treat or prevent iron-deficiency anemia, may be inappropriate in multiple doses, according to the Beers List.

A recent study indicated that for seniors, a single daily dose was as effective as multiple daily doses. Additionally, a single daily dose reduced the potential for constipation.

Mineral Oil

This lubricant laxative helps with bowel movements by coating the bowel and stool mass with a waterproof film. This retains the stool’s moisture, facilitating defecation.

According to the Beers List, there are more effective laxatives that empty the bowels more efficiently without potential side effects, with the panel concluding that mineral oil is neither safer nor more effective than other laxatives.

Mineral oil can predispose seniors and small children to lipoid pneumonia, especially if they have difficulty swallowing. This rare lung disease is caused by inhaling or ingesting fatty substances like mineral oil that accumulate in the lungs.

The professional care team at Monroe Village helps residents lead lives of purpose, engage with the here and now, and feel joy no matter where they may be in the aging process. We offer a full spectrum of senior health care services—including assisted living at Monroe Village and memory care, skilled nursing, and senior rehabilitation services at Village Point. Contact us to find out more.