Includes interview with Dr. Alan Low, BSc. (Pharm.), Pharm. D., RPh, ACPR, RCHSP, CCD
Primary Care Pharmacist and Pharmacy Lead, BioPro Biologics Pharmacy
Clinical Associate Professor, Faculty of Pharmaceutical Sciences, UBC
Many seniors take a variety of medications for different needs, the most common being cardiovascular drugs. They might also take medication for blood thinning, mood disorders, gastrointestinal needs, sleep aid and pain management, amongst other conditions. These medications can include or overlap with drugs used to manage arthritis. In fact, approximately one quarter of seniors in Canada are prescribed 10 or more different types of drugs.
Taking multiple medications to manage your health can be daunting, but flourish is here to help. Dr. Alan Low, a Primary Care Pharmacist and Clinical Associate Professor at the Faculty of Pharmaceutical Sciences, UBC, specializes in medications for rheumatology, bone health and osteoporosis. The Arthritis Society spoke with Dr. Low about medication interactions, medical cannabis and more.
For seniors living with arthritis, Dr. Low notes that disease-modifying antirheumatic drugs (DMARDs) can affect the immune system. This means that other drugs associated with increased chance of infection or further weakening of the immune system may produce a greater risk. For example, drugs that pierce the skin, such as insulin injection for those with diabetes, have increased risk of introducing infection. Dr. Low also says that kidneys don’t function as well as people age, and since kidneys have an active role in removing medication chemicals from your system, dosage of drugs may need to change to reduce the risk of side effects. “Over time, the body becomes more sensitive to medication and less resilient”, says Dr. Low. “Someone may have taken medications when they were young and experienced no side effects, but as an older individual the same drug may give them side effects.”
There are other risks to be aware of, Dr. Low adds. Alcohol can affect the liver and interact with drugs, so alcohol consumption should be discussed with doctors and pharmacists, who may adjust dosage accordingly. Over-the-counter medication should be reported to physicians and pharmacists as well – seniors with a daily over-the-counter medication regimen may need to know of possible interactions. For example, someone taking a non-steroidal anti-inflammatory medication (NSAID) such as ibuprofen, ASA, or naproxen, should let their healthcare team know in case they are prescribed an additional NSAID for arthritis pain management. It’s also important to tell your doctor if you’re changing any over-the-counter drug doses.
Treatment using most medications “involves a pharmacist who can walk you through how to use it and answer any questions,” says Dr. Low, though “this is not the case for medical cannabis.” He notes that when someone receives a medical cannabis authorization, they then order their medical cannabis and have it delivered to their home, which means less opportunity to ask questions. If your doctor can’t provide counsel or education around cannabis use, Dr. Low recommends seeking out additional information through another doctor, such as at a reputable medical cannabis clinic, or even some pharmacies that can provide cannabis consultation.
As with over-the-counter medications and alcohol, you should discuss cannabis use with your doctor. If your doctor authorizes you to use medical cannabis, they will complete a medical document that indicates a quantity and maximum daily dose. It’s important to start low and go slow and learn about the side effects. You can learn more from the Arthritis Society’s Medical Cannabis hub.
Adhere to the Prescribed Dose
Dr. Low says the most important thing seniors – and anyone – should know about their medication is to adhere to the prescribed dose. “Unless someone really understands the drug and their condition,” he says, “it can be a challenge to make the decision on their own to stop, reduce or increase dosage.” He recommends seeking help by talking to a physician, a pharmacist or calling your local telehealth line. Some medication takes longer to take effect than others, like biologic DMARDs, so seniors trying a new medication should know at what point to follow-up and check-in with their health team.
Seniors can learn more about the potential interactions between their medications by speaking to their pharmacist - “they are the drug experts, they have spent their entire training career learning about medication” Dr. Low says. You can also learn more about arthritis-related medications themselves in the Arthritis Society’s Medication Reference Guide.