Last month I discussed medications that are more likely to cause falls in the elderly.  This month I want to focus on potentially inappropriate OTC medications in the elderly.  People are often under the wrong assumption that if it can be bought over-the-counter, it can not be strong enough to cause any serious side effects.  I want to touch on a few medications often used in the elderly that are potentially inappropriate.  This list is definitely not all inclusive.  The medications I will mention are diphenhydramine, NSAIDs, Ferrous Sulfate, and Mineral Oil.

Diphenhydramine, or Benadryl, is commonly used as an antihistamine and to treat insomnia.  Diphenhydramine is discouraged in the elderly due to its strong anticholinergic properties as compared to alternative medications for both allergies and sleep.  There is concern that strong anticholinergic effects may lead to a decline in cognitive function or even precipitate delirium in older adults.  There are increased risks for adverse events such as falls and increased confusion for older adults taking diphenhydramine. ¹

Chronic use of NSAIDs, or nonsteroidal anti-inflammatory drugs, has been associated with the development of GI bleeding, hypertension, renal dysfunction, and exacerbation of heart failure.  The two common OTC NSAID medications are ibuprofen and naproxen.  Ibuprofen is generally thought to have a lower risk of GI bleeding that naproxen.  The key to avoiding GI bleeding associated with NSAIDs is to use the lowest effective dose for the shortest amount of time.  Strong acid inhibitor medications and food can also decrease the risk for a GI bleed. ¹

Ferrous sulfate, or Iron, is used solely to restore body iron stores.  Doses exceeding one tablet daily are considered potentially inappropriate due to an increased risk of constipation as well as evidence that a once-daily dosing strategy works as well as multiple daily dosing. ¹

Mineral Oil is often used as a laxative by older adults.  This medication is considered potentially inappropriate because there are safer and better-working medications that exist.  There is a risk of aspiration and development of lipid pneumonia while taking mineral oil.  Especially if an older adult has swallowing difficulties, mineral oil should be discouraged as a laxative.¹

In conclusion, OTC medications can be potentially dangerous in certain populations such as older adults.  Read the back of the box before you buy, or better yet, ask your pharmacist or physician if you are not sure what would be the safest therapy for your specific condition.

1. Eng, M. (2008).  Potentially Inappropriate OTC Medications in Older Adults.  U.S Pharmacist,  33(6), 29-35.