More than 5 medicines can cause side effectsProfessor Hye-jin Jeon, Department of Family Medicine, Ewha University Seoul Hospital

1. Do drugs have side effects?

Drugs come with side effects along with effectiveness. What I want to talk about here is iatrogenesis. Even with the medicine given by the doctor, a certain disease or a certain symptom can occur again.

Let's take a fall, for example. In foreign patients over the age of 65, there is a story that one elderly patient experiences a fall every 20 minutes. Risk factors for falls include physical and environmental reasons, as well as medications you are taking. This is because, among the side effects of the drug, in addition to dry mouth and constipation, there are also side effects that make you dizzy. The same goes for blood pressure medications and antihistamines. So if you're taking anti-anxiety medications, antidepressants, painkillers, sleeping pills, or muscle relaxants, you need to be careful.

So, if you don't need the medication we commonly take now, it's better to stop (Stop), or switch to another drug (Switch) or take less (Reduce). The reason is that every medicine is like the face of Janus. What I mean by that is that medicine has a good face and a bad face. Medicines have a positive effect, but on the contrary, they also have a bad face and side effects, like a double-edged sword.

2. Criteria for polypharmacy

So, how much medication should you take? The amount varies slightly from one study to another, but in general, taking five or more medications is called polypharmacy. By the way, if the patient does not need it, it is said that 3~4 is a lot. So unless it's a medicine I really need right now, I shouldn't take more than that. Also, if you are an elderly person, it is recommended to take a low dose, but slowly increase or decrease the dose.

Then, how many drugs do people take in our country? According to a survey conducted by the Health Insurance Review and Assessment Service, 86.4% of elderly patients were taking polypharmacy if they took 6 or more of them. However, this survey was not for long-term use, but for people who had taken it for a short period of time. According to a recent report, fewer people took it for more than 3~6 months. So don't worry too much about these numbers, but I want you to remember that more elderly patients are taking more medications than we think.

3. When to watch out for side effects

So, which people should be wary of drug side effects? The following cases are at higher risk, so if you are in this category, you should be careful not to have any side effects.

- If you suffer from a lot of chronic illness

- If you have known any side effects before

- If you are older

- If the kidney function to excrete medicine has decreased.

- If you are taking blood-thinning medications or diuretics

- If you are taking anti-inflammatory drugs, anxiety medications, anticoagulants, diabetes medications, or medications that increase blood pressure

It's called the Snowball Effect, the Prescribing Cascade. For example, your blood pressure may rise when you take painkillers, but you may not be able to get out of the vicious cycle of taking blood pressure lowering medications instead of quitting painkillers.There are so many drugs that have this snowball effect. That's why we should stop taking medicine when we have a symptom, and not take another medicine to treat it.

If an elderly patient has cognitive changes, urinary incontinence, constipation, or envy, diarrhea, gastrointestinal bleeding, etc., it may be caused by any medication. Therefore, when you have a new symptom, you should consider whether there have been any recent changes in medication.

For example, dizziness, dry mouth, and constipation are common in the elderly, and anticholinergics are among those that cause these symptoms. And dizziness and drowsiness, these things can be caused by copurum, cholmin, the antihistamines and the anticholinergics in these medications, so you have to be careful.

In addition, even if you don't solve it with medicine, you should compare whether there are safer alternatives than medicine. Of course, medications are very important for osteoporosis patients, but exercise will definitely help bone density, and pain medications are important for patients with spinal fractures, but braces will definitely help. For people with mild depression, cognitive-behavioral therapy is definitely helpful. And for patients with urinary incontinence, strengthening the pelvic muscle, pelvic strengthening exercises, and saline solutions for nasal congestion can certainly help relieve symptoms. Therefore, it is better not to rely too much on medications and to look for alternative treatments.