Consumer Reports recently published a list of drugs that have heightened risks for older adults, due to the fact that as kidneys age, they lose some ability to process drugs. Consumer Reports compiled a “list of medications that are best avoided by those 65 and older, as well as a list of alternative medications.” See below:

Medicines Older Adults May Want to Avoid

Adverse drug reactions that result in emergency room visits affect older Americans nearly twice as often as young people. One reason is that as the body ages, the kidneys’ ability to process medications declines. As a result, some drugs stick around longer in the body, and others can build up to unhealthy levels if multiple doses per day are required.

At the same time, millions of older Americans take five or more medications a day, which multiplies the risk of experiencing an adverse drug event.

Consumer Reports Health has published new information to help guide people in their drug selections. A list of medications that are best avoided by those 65 and older, as well as a list of alternative medications, is included.

For example, antihistamines Chlor-Trimeton (chlorpheniramine) and Benadryl (diphenhydramine) can cause confusion, sedation and the inability to fully empty the bladder (urine retention) in people over 65. Generic cetirizine (Zyrtec), fexofenadine (Allegra) and loratadine (Claritin) are generally safer bets.

Another example is pain relievers. Aleve and Naprosyn (naproxen), Daypro (oxaprozin) and Feldene (piroxicam) can cause gastrointestinal bleeding and kidney damage. Demerol (meperidine) can cause confusion and falls. Better and safer choices include Tylenol (acetaminophen), Advil (ibuprofen), Zostrix (capsaicin cream) and for severe pain, morphine.

Click here for a complete list of drugs to avoid for older individuals.

Find more information at Consumer Report’s Best Buy Drugs about comparative effectiveness
and comparative cost for many of these medicines.

The Los Angeles Times ran an article today by Fran Kritz, Heading to the drugstore? Clip a coupon — but read the fine print. The article talks about the growing use of retail “coupons” by drug companies anxious to stave off competition, from cheaper generics or other drugs. Coupons are better suited to regular consumer products like shampoo, fabric softener and breakfast cereal than to medical treatment. This is why we here at Prescription Access Litigation oppose the use of coupons for prescription drugs, and why last year we called on the FDA to ban them.

PAL’s director is quoted in the article:

Last year, the FDA posted a federal register notice asking for public comments on the proposed study. The agency has since pulled the notice, spokesman Sandy Walsh said, in order to refine the parameters of the study, but in the meantime, comments voicing opposition to coupons came into the agency. The Prescription Access Litigation Project, for example, a group devoted to lowering the cost of prescription drugs, filed comments representing 23 consumer groups calling for an outright ban on prescription drug coupons. Among the complaints: that coupons interfere with a doctor/patient relationship by leading consumers to ask their doctor for a drug for which they’ve seen or received a coupon, and that they deceive consumers into using high-priced brand names over generics.

“A $10 coupon is nothing compared [to] the long-term savings from using a cheaper generic drug, particularly for long-term maintenance drugs,” says Alex Sugarman-Brozan, the group’s director.

The prices of brand-name drugs that don’t face competition from less expensive generics are completely arbitrary — the manufacturer just sets a price that it thinks the market will bear. So what does a coupon mean in that kind of situation? We compare it to a store that one night raises its prices, and then the next morning announces a sale. How do you know how much you’re really saving? How do you know if you’re getting a good deal? The answer is — you don’t. And brand-name drug companies count on that. They also count on the fact that people think they’re getting a better deal when they get some kind of discount (sale price, coupon, etc.) than when the base price of a product is just lowered. So drug coupons create a false sense of savings.

Drug coupons are also intended to do an “end-run” around health plans’ efforts to steer their members to less expensive but equally effective generic drugs. Let’s say your health plan charges a $10 co-pay for a generic heartburn drug, and a $20 co-pay for an expensive brand-name heartburn drug. The difference to you, the patient, is $10. If you get a $10 coupon for the brand-name drug, you don’t pay any more for the brand-name than the generic. But the generic usually will work just as well as the brand-name. So what’s wrong with that, people may ask.

The difference to the health plan is usually much more. The health plan might be paying $40 or $50 more for the brand-name drug than the generic. So what, you might say. That’s their problem, not mine. That $40 or $50 more the health plan pays doesn’t come out of nowhere — it comes out of your premiums. So next year, your premiums might go up that much more. In prescription drugs, as in life, there’s no such thing as a free lunch.

The article also points out that the savings with a coupon often still don’t match the savings on a generic:

Synthroid, for example, a brand-name drug from Abbott Laboratories that treats thyroid hormone insufficiency, costs $13.99 per month at drugstore .com, versus $8.99 for the generic. But the coupon Abbott is now promoting only takes $3 off of each prescription, making the generic cheaper by $24 per year.

So, next time you see a coupon for a prescription drug, be wary. Ask your doctor if there are generic or even Over-the-Counter options that work as well as the brand-name drug. If you have health insurance, see if your insurance (if you’re insured) has lower co-payments for generics — some insurers are even starting to charge zero co-payments for generics. If you don’t have health insurance, check out RxOutreach.org, a Patient Assistance Program offering deeply discounted generic drugs. And whether you have insurance or not, check out Consumer Reports Best Buy Drugs to see what drugs are the “best buy” for the condition you have.

To read our comments to the FDA, calling on them to ban drug coupons, go here.

Jane Brody’s column today in the NY Times, “Cutting Cholesterol, an Uphill Battle,” is an excellent overview of the lifestyle changes that one should make to lower high cholesterol, BEFORE resorting to prescription statins (Lipitor, Crestor, Zocor, etc).

In addition to the very useful specific advice that she offers (below), perhaps the more important message of her column is “don’t turn to a pill first.” The ubiquitous TV ads for statins, including the ones featuring Dr. Robert Jarvik, have convinced millions of people that all they need to do to lower their cholesterol is take a statin — and an expensive brand-name one at that. Statins can be very helpful and there are no doubt millions of people who can and do benefit from them. But our culture of a “pill for every ill” has given short shrift to the important — but often harder — changes in diet and exercise. The upside is that a better diet and increased exercise have countless other benefits beyond just reducing cholesterol. But when was the last time you saw an ad that said “Ask your Doctor if Broccoli is right for you.”

Even people who do need statins don’t necessarily need the most expensive, newest brand-name ones. Visit Consumer Reports Best Buy Drugs’ report on statins to see which statins are the “Best Buy” and right for different types of patients. Best Buy Drugs reviews a number of different categories of drugs, including drugs of heartburn, migraines, depression, diabetes and others.

Here’s Jane Brody’s advice:

These are the measures that have been found to work, based on randomized, controlled clinical trials, the gold standard of clinical research.

Alcohol. Consuming one or two drinks a day can lower LDLs by 4 to 10 milligrams. Red wine is considered most effective. For those who cannot drink alcohol, purple grape juice may be a reasonable, albeit less effective, substitute.

Exercise. Aerobic exercise, like brisk walking, jogging, cycling and lap swimming, can reduce LDLs by 3 to 16 milligrams and raise the good HDLs. Consistency is important. Aerobic activities should be performed at least five times a week for maximum benefit.

Weight loss. When achieved through diet and exercise, weight loss can reduce LDL levels by as much as 42 milligrams. When achieved through drug therapy, weight loss has been associated with an LDL drop of 10 to 31 milligrams.

Yoga and tai chi. These forms of exercise, which are accessible to just about everyone who can walk, even the elderly, have reduced LDLs by 20 to 26 milligrams when done for 12 to 14 weeks.

Smoking. An analysis of several studies found that LDL cholesterol was 1.7 percent higher in smokers, but two smoking cessation studies found little or no difference. In any case, smoking is a strong independent risk factor for heart disease and sudden coronary death, so it is best avoided.

Modifying Your Diet

About 85 percent of the cholesterol in your blood is made in your body. The remaining 15 percent comes from food. But by reducing dietary sources of saturated fats and cholesterol and increasing consumption of cholesterol-fighting foods and drink, you can usually lower the amount of harmful cholesterol in your blood. My college roommate, for example, recently adopted a mostly vegetarian-and-fish diet, minus cheese but with occasional meat and chicken, and lowered her total cholesterol from 240 to 160 milligrams.

There are exceptions, of course, and I happen to be one of them. Still, I intend to continue to follow a heart-healthy diet, because that will enhance the effectiveness of the medication I’m taking.

Start by switching to low-fat and nonfat dairy products, like skim milk and, if you can stand it, fat-free cheese. Substitute sorbet, sherbet or fruit ices for ice cream, or choose ice milk or ice cream with half the fat.

For protein, choose fish and shellfish, poultry without the skin and lean meats, all prepared with low-fat recipes. Eat more dried beans and peas (cooked, of course), soy products like tofu, and nuts like walnuts and almonds. Grains should be mostly or entirely whole — 100 percent whole wheat bread and cereals made from whole wheat or oats, brown rice, bulgur and the like. Oats and oatmeal are rich in soluble fiber, which lowers cholesterol.

Pile on the vegetables and fruits. Especially helpful are those high in fiber like Brussels sprouts, cabbage, spinach, carrots, blueberries, oranges and apples.

Cook with canola or olive oil, and use margarine made from plant stanols.

And enjoy a glass of wine with dinner.

Equally important are the foods to limit or avoid: organ meats like liver, egg yolks, most fried and fast foods, doughnuts and pastries, full-fat cheeses and ice cream, processed meats like salami, bacon and other fatty cuts of pork, and untrimmed red meats.