Case studies: How a medication review can change a life

Joe, 75 years old

Joe had been diagnosed with diabetes, high blood pressure, high cholesterol, prostate issues, lung problems, and acid reflux, and was on 12 different medications. He was finding it hard to take all of his pills every day.

Joe’s medications were reduced to five, and the dose of some of these was less than before. The five were chosen based on Joe’s priorities for what he most wanted medications to do for him in conjunction with a screen of his medications that identified some potential conflicts between some of them. He finds it a lot easier, less confusing, and less time-consuming to take his medications now. He also feels a lot better — he is less tired and his feet aren’t as cold as they used to be. He feels steadier on his feet. When his blood pressure medications were paused, his blood pressure did not rise to a level that needs treatment (everyone had assumed it was the medication keeping it normal — they had 20 years ago, but Joe’s body and lifestyle are different now, and “normal” levels are different for his age). His lung problems improved after stopping the blood pressure medication, and he found after tapering off the acid reflux medication he didn’t need it any more.

Stephanie, 76 years old

Stephanie was on five medications to prevent cardiovascular disease, as well as Coumadin to thin her blood as she had an artificial heart valve.

The medication review looked at the scientific evidence for Stephanie’s heart medications, as well as her priorities for care. Stephanie decided that the potential benefit was extremely small for her taking the cholesterol pill, and that she preferred to stay on just the Coumadin. Her blood pressure was monitored as she paused her blood pressure medications, and it stayed at a normal level for her age. She found that when she stopped her beta blocker for blood pressure, she no longer needed the diuretic for ankle swelling. She felt better than she had in years — less fatigued, able to walk much farther with her walking group, and her feet were warm for the first time in a long time! Her thinking was clearer when she stopped the cholesterol medication.

Heather, 78 years old

Heather moved to long-term care after a bout of pneumonia. She was on nine medications. She had significant problems with agitation, delusions, and the inability to tell dreams from reality. She had bladder problems and chronic pain in her back, as well as difficulty sleeping. She was “sleeping” and difficult to rouse even during the day — not a normal nap. She had unexplainable, sudden sweating, episodes of rapid heartbeat, a lack of coordination, and was prone to falling.

The medication review showed that several drugs, all added one at a time for her mood, back pain, and delusions, were interacting, resulting in additive side effects and giving her serotonin syndrome. The burden of drugs causing anticholinergic and sedative effects was also high. After discussion with Heather’s family, she had a trial “drug pause” from many of these drugs to assess what benefit they were really having, and her family and caregivers were amazed to see that the “old” Heather was back again. She was no longer confused, recognized her family, and her sharp sense of humour returned. Her symptoms of sweating and her repeated falling vanished. Heather had three more years of real quality time to spend with her family.

Don, 68 years old

Don was on medications for gout prevention, high blood pressure, and acid reflux. He felt fine but was interested in optimizing his medication.

Don’s blood pressure was excellent, and he had a trial of tapering two of his three blood pressure medications. His blood pressure rose again, and he restarted one of them, but at a lower dose than previously, which gave good control. He tapered off his reflux medication and gets symptoms occasionally but just has a few pills that he takes “as needed” rather than continuously. He is doing more exercise and has improved his diet to help his reflux symptoms and is hopeful that this will also reduce his blood pressure enough to reduce to one medication to control it.