There are a lot of examples that fit this criteria and I suspect a lot of heavy opinions on this topic. I’ve certainly made suggestions to switch to a likely “safer” medication, but have had instances where I disagree with this practice as well in our elderly patient population. Is age a reason to change a medication? I lay out some questions to consider.
A couple examples that come to mind are the appropriateness of TCA’s and Benzodiazepines in the elderly. Using the TCA example, nortriptyline is generally preferred if a TCA needs to be used. So, if we have a 75 year old patient on amitriptyline, should we switch them to nortriptyline, or potentially off of a TCA altogether.
While it would be inappropriate to make a blanket statement, I want to give you some points that I think about when considering a transition.
- Is the current medication effective? If this patient is on amitriptyline and it isn’t effective, this is likely an easy call to switch them to another medication.
- Are there obvious signs of adverse effects? Dry eyes, dry mouth, increasing confusion, etc. If so, another easy reason to ask for a switch.
- If the current medication is effective, and no side effects have been noted, I’m going to assess the degree of the effectiveness. If the patient states that the benefits of the medication have been “life changing”, it certainly makes it a lot harder to try to convince them an alternative might be better/safer.
- What have they tried? Many elderly patients have been tried on numerous medications and are very reluctant to go through those trials again. Be sure to do your best to attempt to find this information out before making a recommendation.
- One last point is how long they have been on it and at what dose. If they are on a high dose, has a reduction ever been tried? If they are on a low dose, have they ever tried off of it?
What did I miss?
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What would you say to a patient who has been on Adderall for decades as he or she approaches the young elderly age group? Continue if it has been working for them? Also, I did a presentation on methylphenidate for depression in the elderly. I am wondering if Adderall could be useful for this as well. Thoughts?