Is Your Medicine Cabinet Making You Sicker? The Dangerous Chain Reaction You Should Watch For

According to recent data from the Lown Institute, 42% of older adults take at least five prescription medications regularly.

That’s risky, as those medications may not mix well. The result for millions of Americans can be costly emergency room visits, hospitalizations and even death, the Lown Institute says.

“Focusing on reducing inappropriate or unnecessary medications could save as much as $62 billion over the next decade in unnecessary hospitalization for older adults alone.”

It starts with a prescribing cascade, which can happen when a medication causes a side effect that’s mistaken for a new medical condition, leading to yet another prescription.

If you’re taking multiple medications, read on to learn how the cascade happens and how you can work with your doctor to stop it.

How the cascade happens

Let’s say, for example, that your doctor gives you a prescription to treat you for high blood pressure. Calcium channel blockers (like amlodipine) are highly effective at lowering blood pressure, but they can often cause fluid retention in the legs.

If a doctor sees swollen ankles and diagnoses edema instead of a drug side effect, they might prescribe a diuretic like furosemide.

Soon, the diuretic makes you rush to the bathroom constantly, so you’re given a bladder control pill.

That diuretic might then lead to urinary urgency or incontinence. If that new symptom is treated with an anticholinergic drug (like oxybutynin), you might start experiencing confusion or dry mouth — symptoms that mimic cognitive decline.

The warning you and your doctor need to hear

Geriatricians have long fought against the mentality of “one pill for every ill.” Their primary weapon is the Beers Criteria.

Maintained by the American Geriatrics Society, the Beers Criteria is a list of medications that are potentially inappropriate for older adults. It flags drugs that carry higher risks of side effects — such as confusion, falls or internal bleeding — than benefits for people over 65.

The 2023 update highlighted several critical changes.

For example, it strengthened warnings against using aspirin for the primary prevention of heart disease in older adults due to bleeding risks. It also advised avoiding rivaroxaban (Xarelto) for long-term treatment of atrial fibrillation in favor of safer alternatives, as the bleeding risk increases significantly with age.

Use the criteria to help you ask better questions at your medical visits. If you’re prescribed a drug on this list, it’s worth asking if there’s a safer alternative.

4 ways to break the cycle

Here are a few proactive steps that can help you catch a cascade before it starts.

1. Ask about side effects

Whenever you develop a new symptom, ask your doctor directly: “Could this be a side effect of one of my current medicines?”

Never assume they’ve already checked. Specialists often don’t communicate with one another. So your cardiologist might not realize what your rheumatologist prescribed.

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2. Request a review

Once a year, put every single medication you take — plus vitamins, herbal supplements and over-the-counter painkillers — into a bag and take it to your primary care doctor or pharmacist for a full review.

Supplements can interact with prescriptions in dangerous ways (for example, ginkgo biloba can increase bleeding risk if you’re on blood thinners). Seeing everything together often reveals duplications or outdated prescriptions that can be safely stopped.

3. Ask about deprescribing

Deprescribing is the planned, supervised process of reducing or stopping medications that may no longer be beneficial. It’s just as important as prescribing. If you’ve been on a medication for years, ask if you still need it.

Bodies change, and a dose that was perfect for you at 50 might be harmful at 70.

4. Start low, go slow

If you must start a new medication, advocate for the lowest effective dose. Older kidneys and livers often process drugs more slowly, meaning standard doses can build up to high levels in the body, triggering the very side effects that start a cascade.

Your medication list should support your life, not complicate it. By staying curious and keeping your doctors informed, you can ensure that every pill you take is truly necessary.