Medications we take for years... When does reviewing them become a necessity?

Health Awareness and Information Specialist, Dr. Pharmacist Rawan Abdul Salam, emphasized that the decision to reduce the dosage of medication or stop it is not up to the patient, but to the treating physician after evaluating the condition and conducting the necessary tests.

She pointed out in an interview with 'Alrai' that some patients with high blood pressure or type 2 diabetes may improve their condition after losing weight, following a healthy diet, and exercising. In such cases, the doctor may decide to reduce the dosage or stop some medications if the condition allows.

Abdul Salam stressed that improved test results or the patient's feeling that they are better do not justify self-stopping treatment, especially in chronic diseases, as sudden cessation of certain blood pressure and diabetes medications can lead to serious complications.

She explained that aging may change the body's response to medications, and kidney and liver functions, which are responsible for eliminating many drugs, may decline, which may increase the risk of their accumulation and toxicity.

She added that changes in weight, pregnancy and lactation, adding a new medication, or the appearance of side effects such as dizziness, drowsiness, skin rash, and stomach problems, are all reasons that necessitate reviewing the treatment.

Abdul Salam warned that taking multiple medications from more than one doctor without informing each of them about the complete list may lead to duplication of active ingredients or drug interactions, urging patients to keep a list that includes prescribed and non-prescribed medications, supplements, and herbs, and to show it to the doctor or pharmacist.

She described the indiscriminate use of painkillers as one of the most noteworthy practices, pointing out that persistent pain despite taking painkillers may be an indication of a problem that needs diagnosis rather than increasing the dosage.

She noted that exceeding the allowed doses of paracetamol can cause toxicity and liver failure, while non-steroidal anti-inflammatory drugs, such as ibuprofen, naproxen, and diclofenac, may be associated with stomach problems, bleeding, high blood pressure, fluid retention, and kidney complications, in addition to increasing some cardiovascular risks.

She also warned against the use of opioid painkillers without a prescription, as they may cause physical and psychological dependence, and exceeding their doses may lead to respiratory depression, coma, and death.

Regarding antacids, Abdul Salam pointed out that their long-term use without medical supervision may affect the absorption of important elements and vitamins, including vitamin B12, iron, calcium, and magnesium, noting that the prolonged use of some of them is associated with increased risks of deficiency and weakened bones, and there are studies linking prolonged use with some kidney problems.

She also warned against continuing certain nasal decongestant sprays and drops, which contain substances such as oxymetazoline and xylometazoline, for more than the recommended duration, usually 3-5 days, as overuse may lead to what is known as 'rebound congestion,' where congestion returns more severely and the person becomes dependent on the spray to breathe comfortably.

She emphasized that treating vitamins and supplements as safe just because they are from natural sources is a misconception, explaining that their need, dosage, and duration of use should be determined according to the condition and tests.

According to Abdul Salam, fat-soluble vitamins A, D, E, and K can accumulate in the body, and excessive vitamin D, for example, may raise calcium and cause kidney problems, while the fact that some other vitamins are water-soluble does not mean that taking them in high doses and for long periods is risk-free.

Abdul Salam also warned against stopping or changing the dosage of certain medications on one's own, especially chronic disease medications, sedatives, hypnotics, opioid medications, and corticosteroids, in addition to the need to adhere to the specified dosage and duration for antibiotics.

She explained that sedatives and hypnotics may require gradual reduction under the supervision of a physician to avoid withdrawal symptoms, and corticosteroids used in certain conditions should not be stopped abruptly, but according to a plan determined by the doctor.

Abdul Salam pointed out that the most important rule is not that 'every chronic medication is taken for life,' nor that the patient can stop it when they feel better, but that the need for medication and its dosage change according to the condition, and the decision remains with the treating physician based on follow-up and tests.