The Deadly Pills Lurking in Your Medicine Cabinet

Imagine celebrating your birthday slumped over in your seat at a restaurant.

(And it wasn't from drinking too much, either.)

That was Mary, freshly turned 93 – and fast asleep at Olive Garden where her whole family had gathered.

But she had seemed "out of it" before then, too. "She couldn't hold a conversation or even finish a sentence," her daughter Leslie told the New York Times three years later in 2021.

The experience at Olive Garden finally spurred Leslie to book her mom an appointment with a geriatric-medicine specialist at Johns Hopkins Hospital. There, Mary took a test to check for cognitive impairment.

She failed spectacularly, getting only three of the 30 questions right.

Mary had also long been dealing with health conditions common for her age: hypertension, diabetes, nerve pain, and anxiety. And she was taking 14 different drugs.

One was an acid-reflux medication that Leslie couldn't remember why her mom even needed in the first place. Another made Mary's blood-sugar levels too low.

Mary was a victim of an epidemic that'll only get worse...

The Polypharmacy Epidemic

Polypharmacy is generally defined as being on more than one medication at one time – usually more than five daily meds. It affects 37% of the total population. But it's even more common in older adults...

A 2021 PLOS One study of more than 2 billion patient visits for folks aged 65 and older found that from 2009 to 2016, as many as 65% of older Americans fell victim to polypharmacy. And like Mary, about 49% were on five or more drugs.

Medications come saddled with all sorts of possible side effects in addition to their intended effect. So the more complex medications you're taking, the higher your chance of suffering serious symptoms or even dying from them.

In fact, polypharmacy patients have a 50/50 chance of suffering harm from an adverse drug interaction. Altogether, polypharmacy costs our country roughly $177 billion per year, most of it from hospitalizations.

Take, for example, blood thinners... You probably (and hopefully) know the risk of excessive bleeding if you take this medication. But a March 2024 study found that if you're on blood thinners and you're one of the tens of millions of Americans prescribed a common antidepressant (i.e., an SSRI), here's the bad news... Your risk of suffering severe bleeding spikes 33%.

Drug interactions aside, polypharmacy also increases your chances of getting prescribed a medication that'll do more harm than good, or a "potentially inappropriate prescription."

And that ups your risk of having...

• Your health harmed by the medication in an adverse drug event.
• The medication interact with another drug you're taking, leading to unexpected side effects.
• The medication interact with – and worsen – an existing disease or condition.

Finally, polypharmacy exposes you to what's called a "prescribing cascade."

That's where a medication's side effects get mistaken for symptoms of a new illness. And then your doctor tacks on a prescription for another medication to handle those symptoms... which, of course, opens you up to potential side effects from that new drug.

A study from Ireland published last month looked at prescription data for 533,464 seniors between 2017 and 2020. Here were some of the prescribing cascades researchers found...

• Getting prescribed a diuretic due to side effects of swelling from a calcium-channel blocker (for high blood pressure)
• Getting prescribed a dizziness drug due to side effects from a drug to treat an enlarged prostate
• Getting prescribed a sleeping drug to combat due to a side effect of insomnia from taking an antidepressant
• Getting prescribed a drug to treat Parkinson's disease symptoms due to movement problems as a side effect of an antipsychotic drug.

So how can you avoid all of this?

Be Your Own 'IRS'

That is, be your own "Internal Remedy Service."

Regularly do an audit of any and all remedies you're taking. That includes over-the-counter drugs, prescriptions, vitamins, and supplements you regularly take and have recently taken or discontinued. One way to start is to...

"Brown bag" it. Leslie did something like a "brown bag" review for her mother's medications. This term, coined in 1982, refers to chucking all of your prescriptions into a bag and having your doctor or pharmacist review them for any new recalls or dangerous drug interactions. Your provider can also reevaluate whether the dosage should be adjusted.

Or perhaps, if your provider determines that the potential harm outweighs the potential benefit of taking the medication, you can even stop taking it, which is called "deprescribing." A systematic review and meta-analysis published in May's JAMA Network Open found that deprescribing was linked to a reduction in potentially inappropriate prescriptions.

Whipping up a list like Leslie's gives you a more portable solution. Jot down details like:

• The name of the drug (generic or brand name).
• The long National Drug Code ("NDC") made up of three groups of numbers (separated by dashes or asterisks) on your prescription label and over-the-counter packaging. It'll let your provider know of any recalls. The three groups, in order, identify: the "labeler" (i.e., the drugmaker), what the drug is, and the packaging (i.e., the size and quantity).
• How often and what time you take it.
• How you take it (i.e., the form it comes in, like a shot versus a pill, and whether you take it with food).

At the bare minimum, do a full medication review once a year at your annual physical (or biannual visit for most seniors). Even better, do it any time you see your primary-care doctor or specialist.

Thanks to Leslie taking the first step, Mary's specialist outlined a plan to whittle down her laundry list of meds.

But Leslie didn't stop there... She also "went online and looked everything up" and "started questioning her doctors" at subsequent appointments.

She'd ask questions like whether her mom still needed to take a drug, whether the dosage could be lowered, and whether she could even stop taking it.

That leads me to my other tip...

Speak up and read up. The next time your provider prescribes a new medication, ask for a medication review. And be sure to ask questions like:

• How long will it take to work?
• How long will it take to see any side effects?
• How safe is it?
• Can it interact with any of the other meds I'm on?
• How much will it roughly cost? Is there a generic version?
• How should I store it?

Even if your doctor tells you that it's safe, always double check...

Go home and read up on the medication yourself. You might even find a "black-box warning" that your doctor may have glossed over. It's the strongest warning that the government slaps on a label if a drug's side effect can seriously harm your health, put you in the hospital, or even kill you. You can also check drug interactions here.

Thanks to Leslie being proactive, Mary's follow-up visit 10 months later was a complete 180 from the last visit. Mary was alert, responsive, and scored a 25 out of 30 on the cognition test. Her next birthday was also a reversal from the prior year's... As Leslie put it, her mom "was the life of the party" at her 94th birthday celebration.

Medications can completely change your life for the better – or for the worse. As I always say, you are your own health advocate. The same goes if you're the one managing a loved one's care.

So be fearless – ask questions and get answers. And know what you're putting in your own body.

P.S. Each of us has a "Wizard of Oz" in our bodies...

It's a tiny organ that most of us don't give much thought to. But it's one that exerts a powerful influence... controlling nearly every other major organ. And if this "Oz" goes on the fritz, you could end up with symptoms that mimic those of common chronic conditions from heart disease to depression to dementia and more. Be sure to check out my latest Retirement Millionaire issue or grab a trial subscription here.

What We're Reading...

• Tips on talking to your doctor about safely deprescribing medications.
• Something different: Could cinnamon could affect how your body metabolizes drugs?

Here's to our health, wealth, and a great retirement,

Dr. David Eifrig and the Health & Wealth Bulletin Research Team
July 22, 2025