A recent article on medscape.com, a very informative medical website, had a lot to say about three classes of drugs that have become ineffective, or at least less effective in the elderly. This lessening of the potency of these drugs has come about because after years of taking them, our reactivity, or susceptibility, to their effects has become blunted and suppressed, and effective doses are nearing levels that could become harmful in one of several ways. The three drug classes are benzodiazepine tranquilizers, broad spectrum antibiotics, and aspirin.
Benzodiazepines (Benzo’s colloquially) are sedative tranquilizers. The trade names of Xanax, Valium, Ativan, Klonopin, and Librium are well known to the public. For those of us folks over 65, taking them can be problematic because aging causes greater susceptibility to their effects, ie. effects occur at lesser doses. So, if the physician and the patient’s family aren’t as vigilant as need be, overuse will cause the patient to have problems with balance, coordination, and cognition. Impairment of these senses sets up the elderly for falls which can have all sorts of consequences. Benzo’s and the elderly are a dangerous combination because of the problems already mentioned but also because the high rate of dependence. Limiting their use, or better yet avoiding them is advisable.
Antibiotics are the second drug class of concern. Broad spectrum antibiotics like Cipro, Levaquin, and Augmentin are prescribed so frequently to young or middle aged adults that resistant bacteria develop causing them to become less effective for older patients. The tendency among infectious disease specialists these days is to be less likely to prescribe antibiotics as was the tendency 10-20 years ago. Some problems have been shown to improve with just supportive care, and prescribing antibiotics as a last resort. One example the article cites is acute diverticulitis and how it often improves with supportive care. The article says, “with antibiotics, the more you use the less they work.” The new thought is to limit antibiotic use to situations that definitely require them.
The last drug that seniors overuse is aspirin. Somehow, every senior citizen thinks they should take aspirin for the prevention of coronary disease—so they do. But aspirin has only been recommended for secondary prevention—meaning patients with known cardiovascular disease should take aspirin to prevent recurrence of CV events. There is “scant evidence” for primary CVD prevention so aspirin is not recommended in these patients. The risk of bleeding outweighs the benefit for primary prevention. Aspirin, then, should only be used by patients with known coronary disease, heart attack, stroke, or other vascular event.
I think the overriding purpose for this article is to warn physicians against causing polypharmacy in the elderly. Seniors have so many problems, and the almost automatic response from physicians is to prescribe a medication for each problem. So one after another, medications are prescribed that were intended to be short-term, but never are discontinued, and polypharmacy slowly evolves. All drugs have adverse effects, some more severe than others. Benzo’s, antibiotics, and aspirin all have their place, but all can cause serious unwanted problems. The emphasis by the author(s) was obvious—that limiting the use of all three classes of drugs prevents polypharmacy, and reduces the risks of accidental overdose, antibiotic resistance, and internal bleeding. These are real serious problems that 85 year olds are best to avoid.
Reference: Span P. Three Common Drugs Older Adults May Be Overusing medscape.com 2026 September 18.
