When is it safe to reduce your medications?

mmoran
|
Posted: Aug 11, 2018 8:31 AM
Here's a situation our fine doctors are pleased to encounter all the time. For 6 months, Patient Ingrid, we'll call her, has been taking a "cocktail" of prescription and non-prescription meds, plus supplements. She's also been eating a newly healthy diet, and exercising regularly. One fine day, she announces "I'm feeling so much better, doctor. Can I stop taking any of my meds?" Great news, but a delicate moment. Ingrid is one of the millions of Americans who toss down that meds and supplements cocktail every day. And she's also one of millions who have made significant lifestyle improvements. Of course, we'll be happy to reduce or eliminate any non-essential meds.

Which drugs are non-essential?

Roughly two thirds of American adults, more than 131 million people, take prescription medications. Adults 50 – 64 fill an average of 13 prescriptions a year. For adults over 65, that number jumps to roughly 20. Everything we put into our bodies interacts with, well, everything that's already there—our blood, our organs, and most importantly in this situation, our meds and supplements. On a good day, all of these interactions are well understood, predictable, and effective. But with so many variables in play, including the profound benefits of diet and exercise, how do we know which ingredients in the “cocktail” can be safely reduced, replaced, or eliminated as a patient's condition improves? The focus here is largely on prescription meds.  If they're all playing nicely together, will changing one of them bring unwanted changes in the others? Maybe.  Maybe not. That's why I advise in the strongest possible terms that you talk with your doctor about how to "wean" yourself off a prescription med. Going cold turkey without your doctor's knowledge and advice can land you in the ER or, worse, push back any progress you've made. Stopping many antidepressants, anti-anxiety drugs, heartburn meds, corticosteroids, and sleeping pills, for example, can actually worsen the symptoms the drug was meant to treat. And if you’ve been taking
opioids such as OxyContin, Percocet, or Vicodin for more than a couple of weeks, going cold turkey can trigger withdrawal symptoms including anxiety, muscle aches, nausea, vomiting, diarrhea, sleeplessness, and tragically, suicidal thoughts that are acted upon—you've seen the headlines.

Make an action plan

Be sure your doctor knows every prescription and nonprescription drug and supplement you've been taking. Then work with your doctor to make a detailed plan for weaning off a given medication:
  • Make a clear timeline for changing your dose.
  • Schedule follow-up appointments to monitor your progress.
  • Ask about temporary effects you can expect that aren’t cause for concern
  • Ask about temporary effects that are cause for concern—serious ones that demand a call to your doctor.
  • Discuss non-drug options you can try. For example, adding 30 minutes of physical activity daily may help control your blood pressure, or trying acupuncture, massage, spinal manipulation, cognitive behavior therapy, or yoga may help manage stress, anxiety, insomnia or pain.
And don’t get discouraged if you need to change your plan. It may take some trial and error to find what works best for the unique person you are. Take good care.