Medications Archive

The pain from an arthritic knee can be intense, limiting daily activities and independence. Men can try a range of medications, but overall acetaminophen (Tylenol, other brands) appears to relieve pain only slightly better than a placebo pill, according to a research review in Annals of Internal Medicine.

The researchers pooled results from 137 randomized clinical trials involving about 33,000 people with knee arthritis and compared the relative effectiveness of the following treatments:

Many men consider taking a daily low-dose aspirin to reduce the chance of having a heart attack or stroke. You should do so only if the chance of being helped outweighs the chance of triggering unwanted bleeding, since aspirin interferes with normal clotting. But about one in 10 men who take protective aspirin may not really qualify, according to a national study in the Journal of the American College of Cardiology.

Experts recommend that aspirin might be considered in someone whose chance of experiencing a cardiovascular problem is at least 6% in the next 10 years. At that tipping point, the chance of being helped is great enough to justify the risk of unwanted bleeding.

Q. I take several medicines to get my blood pressure under control, and they seem to do the job. However, I get dizzy at times. Is there anything I can do, other than stopping my medications?

A. Many people occasionally feel dizzy if they stand up too quickly, and the older you get, the more likely this will happen. When you're lying down or sitting, less blood pressure is needed to send sufficient blood to the brain. But as you stand, the pressure must rise to deliver adequate amounts. If that doesn't happen fast enough, your brain can't function as well as it should, and you feel dizzy. Moving from a lying or seated position to a standing position more slowly usually helps if this is the underlying reason.

Tried-and-true methods, plus the latest electronic reminders and gadgets.

If you have high blood pressure, there may be better alternatives.

Anticholinergics, a group of medications that includes many over-the-counter and prescription drugs, are well known for causing confusion in older adults. Common medications with anticholinergic properties include medications to treat overactive bladder, such as oxybutynin (Ditropan); medications to treat allergies and sleeping problems, such as diphenhydramine (Benadryl, Sominex, Unisom); and medications used to treat depression, such as amitriptyline (Elavil). It's generally believed that confusion that may develop from anticholinergics clears up when someone stops taking the drugs. But now it appears that the medications are associated with a more permanent effect. A study published online Jan. 26, 2015, in JAMA Internal Medicine linked daily anticholinergic use among older adults for three or more years to an increased risk for developing dementia and Alzheimer's disease.

The study didn't prove that anticholinergics cause dementia; it only found an association between people who take the medications and people who develop dementia. Nevertheless, the researchers suggest that doctors avoid prescribing anticholinergics when possible, or at least limiting the medications to the lowest doses possible. If you're taking an anticholinergic, talk to your doctor about the risks the medication poses, including the risk of falls as a result of confusion.

Although these powerful pain relievers can be addictive, opioids are safe for most people when used properly.

Medications called anticholinergics are used to treat a host of conditions—overactive bladder, depression, allergies, and Parkinson's disease. They usually aren't recommended for older adults because one of the most common side effects is confusion and difficulty reasoning. Early studies have also indicated that long-term anticholinergic use is associated with an increased risk of dementia, and a recent study by researchers at the University of Washington adds more evidence to support that connection. The results were published online Jan. 26, 2015, by JAMA Internal Medicine.

The researchers tracked almost 3,500 men and women ages 65 and older who were free of dementia. When they matched prescription data for the previous 10 years with the participants' health outcomes, they determined that using anticholinergics was associated with an increased risk of developing dementia. Moreover, dementia risk increased with the dosage of the drugs and the length of time they were used. While people who had taken these drugs daily for the equivalent of three months had no increase in risk, those who had used them for over three years had a 54% greater risk than nonusers.

Adding medications to foods and trying new swallowing techniques can help.

Swallowing pills can be difficult and downright unpleasant. It causes one in three people to gag, vomit, or choke. That may keep people from sticking to their medication routines, which can make them sicker. "We often see people who can swallow food and liquid just fine, but have difficulty with pills," says Denise Ambrosi, director of the Speech-Language Pathology Department at Harvard-affiliated Spaulding Rehabilitation Hospital.

Simple strategies can help you regain control.

As men age, the simple act of urinating can get complicated. Prostate surgery often leaves men vulnerable to leakage when they cough, sneeze, or just rise from a chair. Or the bladder may become impatient, suddenly demanding that you find a bathroom right now. "Thousands of years ago, it was not as much of an issue," observes Dr. Anurag Das, a urologist at Harvard-affiliated Beth Israel Deaconess Medical Center. "There were lots of trees, and you could just find one and go."

But tricky bladders can be whipped into shape. The first step is a careful assessment of what triggers those difficult moments. Then your doctor can suggest helpful strategies and possibly medication to improve urinary control.