Patients will often ask why physicians would recommend a medication change, refuse to write for a desired new prescription or even discontinue a medication that a patient has been on for many years.
There are many reasons, but above all is patient safety. Oftentimes, an older medication with side effects or a narrow therapeutic window was the only medication we could use to treat a particular problem. Both the patient and the physician would then have to live with the risk of an adverse side effect to gain a benefit. A good example is in the comparison of the three classes of antidepressant medications. The older antidepressant classes have a very similar therapeutic effect compared to the newest class of antidepressants, but the newer medications have less side effects and interactions, which is the main reason they are prescribed more than older ones.
Another reason is that as we get older our ability to metabolize medications decreases, and what were perhaps annoying side effects in the past can become life-threatening complications. Heart arrhythmias, falls, and worsening kidney function, are just a few of the complications that older patients may experience on medications more than younger ones. That’s even if the dose has stayed the same over years. Also many patients, as they get older, are on more and more medications, which makes it extremely difficult for any practitioner to sort out a myriad of potential harmful medication interactions. In this regard, we are now being helped by alerts sent from pharmacies, electronic medical records, and even from insurance companies, but ultimately it is the healthcare provider, who must make the final decision on whether a medication is safe or appropriate to use. Be assured at Casalim Family Medicine we have your health and best interest in mind if we do not write for a medication, change or discontinue an older one. Have a great 2021! We hope to see you soon.