In later life, weight loss can be a double‑edged sword. A few pounds off the joints can be both helpful and risky. Shedding a few pounds may ease joint pain, but losing weight without meaning to can be a warning sign. Fast weight loss can also lead to muscle loss, which is key to staying independent.

Experts also point out practical issues: injections need good vision, steady hands, and a regular routine. Stomach and bowel side effects can be tougher for seniors, especially if they’re already losing weight without trying. complicate life for older adults — and how to approach them with a “safety first” mindset.

1) Aging changes the risk–benefit math (even when a drug “works”)

Older adults, especially those who are frail or have several health issues, are often left out of clinical trials. This is important because average trial results may not match the real-life experience of a 75-year-old who takes several medications and needs to manage appetite and hydration.

A 2024 debate paper on GLP-1 drugs in older patients, including those with kidney disease, points out that limited trial data and multiple medications make it harder to judge safety and effectiveness for frailer seniors. Clinicians need to make decisions based on each person, not just on averages. In simple terms, the real question is not whether GLP-1s are good or bad, but whether they help this specific older person with their unique health needs.

There’s another subtle issue: in later life, the goal is often less about chasing an ideal weight and more about protecting function—walking safely, rising from a chair, maintaining balance, staying hydrated, and maintaining enough strength to live independently. So for older adults, the most important question isn’t “How much weight will I lose?” It’s “What will this do to my strength, my nutrition, and my ability to stay steady on my feet?”

2) Common side effects can become serious for older adults.

GLP-1s often cause nausea, vomiting, diarrhea, constipation, and less appetite. Younger people may find these symptoms unpleasant but manageable. For older adults, though, these issues can quickly lead to dehydration, dizziness, and falls, especially if they also take blood pressure medicines or diuretics.

Current FDA labeling for semaglutide products highlights this pathway: stomach and bowel side effects can lead to volume depletion, and acute kidney injury has occurred, including in postmarketing reports. The label advises monitoring kidney function when starting or increasing doses in people who develop severe gastrointestinal reactions, and it notes that dehydration has been part of reported kidney injury cases.

This is how many real-life problems start: a few days of not being able to eat or drink much, then feeling lightheaded, falling, or needing emergency care for dehydration. Older adults may not feel as thirsty and may have less ability to recover. So, it’s important to watch hydration, electrolytes, blood pressure, and kidney function, especially in the first months of treatment and after increasing the dose.

3) Muscle and frailty: losing weight does not always mean better health.

The headline benefits of GLP‑1s often focus on pounds lost. But the body doesn’t lose only fat. Lean mass (including muscle) can drop, too. This matters in older adults because age‑related muscle loss (sarcopenia) is already common — and it’s tightly linked to frailty, falls, and loss of independence.

A 2025 mini-review on older adults warns that starting and stopping GLP-1s repeatedly can change body composition, sometimes leading to ‘sarcopenic obesity’ — having too much fat and too little muscle. The authors are not saying to avoid GLP-1s, but to remember that weight loss does not always mean better health for older people.

More pointedly, a 24‑month retrospective cohort study in older adults with type 2 diabetes reported that semaglutide use was associated with muscle loss and functional decline, particularly at higher doses and in patients who already had sarcopenia. The authors emphasize individualized risk–benefit assessment and the need for monitoring and intervention.

If you’re reading this as an older adult, it may help to translate the research into plain questions to bring to your next appointment: “If I lose weight, how will we protect my muscles?” “How will we check whether I’m getting weaker?” “What would make us stop or change course?” An older adult who becomes “smaller but weaker” has not gained health — only risk.

4) Other complications: gallbladder, pancreas, vision, and low blood sugar

Gallbladder and bile duct problems can be an unexpected issue. Losing weight already increases the risk of gallstones, and GLP-1s seem to increase it even further. A large review found that using GLP-1 drugs increases the chance of gallbladder or bile duct disease, especially at higher doses, for longer periods, or when used for weight loss.

For older adults, this might present as sudden pain in the upper right side of the belly, nausea, fever, or pain spreading to the back or shoulder. These symptoms should be checked by a physician right away.

GLP-1 drug labels also warn about the risk of sudden pancreatitis and say to get medical help for severe, ongoing belly pain. The overall risk is low, but older adults may have additional risk factors, such as gallstones or high triglycerides. Severe belly pain in later life should always be checked quickly.

Then there’s the risk of blood sugar dropping too low. GLP‑1s don’t usually cause hypoglycemia by themselves, but the risk rises when combined with insulin or sulfonylureas. Semaglutide labeling warns that concomitant use with an insulin secretagogue or insulin may increase the risk of hypoglycemia and may require dose reductions of those agents.

In older adults, hypoglycemia can be particularly dangerous: it can cause falls, confusion, fainting, and cardiac stress. It’s also easier to miss, because symptoms may look like “just being tired” or “a little off today,” especially in someone who already has memory or balance problems.

Eyes and vision deserve special attention. Semaglutide labeling includes a warning about diabetic retinopathy complications and recommends monitoring patients with a history of retinopathy. Beyond labeling, post‑marketing safety monitoring continues to explore visual signals.

A 2025 analysis of FDA adverse event reporting data found a potentially elevated risk of vision‑impairment reports with semaglutide use compared with some other diabetes and weight‑loss medications, and it called for vigilant surveillance and further research. That doesn’t prove the drug causes vision loss in an individual patient, but it is enough to justify a cautious posture: new blurring, blind spots, or sudden changes deserve a same‑week medical call, not a “let’s see if it passes.”

5) Surgery and sedation: delayed stomach emptying can cause problems

GLP‑1 medications slow stomach emptying — one reason people feel full sooner. But that same effect can complicate anesthesia and deep sedation if food remains in the stomach despite standard fasting. A 2024 review describes the connection between GLP‑1 medications, delayed gastric emptying (including gastroparesis), and increased risk of aspiration during anesthesia, as well as possible effects on the absorption of other medications.

This issue has become important enough that several medical groups have created guidelines for surgery. The 2024 guidance says many people can continue taking GLP-1s, but doctors should look for higher-risk situations, such as people with stomach problems or other risks of food entering the lungs, and adjust plans as needed.

This is important for older adults because they are more likely to undergo procedures requiring sedation, such as colonoscopies, joint injections, cardiac procedures, dental work, or surgeries. The easiest and most often missed safety step is to tell every physician involved — surgeon, anesthesiologist, endoscopist, dentist — that you are taking a GLP-1 medication and when you last took it. Do not assume it will be clear in your medical chart.

6) A senior‑friendly “yes, with a plan” approach

If you’re an older adult considering a GLP‑1 (or already taking one), a safer approach often looks like “yes, with monitoring.” That means starting with function, not just the scale: tracking energy, steadiness, and strength in everyday life, not only pounds.

It also means treating hydration as a real medical concern. Ongoing nausea, vomiting, or diarrhea is not just part of getting used to the medicine. These symptoms can affect blood pressure and kidney function, especially when changing doses.

Because muscle matters so much in later life, protecting it should be part of the prescription. That can include discussing protein intake, adding a realistic strength plan (even chair‑based work or physical‑therapy guided resistance), and reassessing the medication if weight loss is accompanied by weakness, poor balance, or reduced stamina.

Older adults should also have their medications reviewed with a focus on preventing low blood sugar. If insulin or a sulfonylurea is being used, doses may need to be adjusted as appetite decreases and blood sugar improves.

Finally, it is important to take symptoms seriously. New stomach pain, ongoing vomiting, or sudden vision changes should be checked by a doctor right away. Before any procedure with anesthesia or deep sedation, make sure to tell the medical team about your GLP-1 use — do not assume they already know.

The GLP-1 medications can help some older adults, but there is less room for mistakes. Side effects can quickly lead to dehydration, frailty, falls, or problems during procedures. The safest approach is not just ‘yes’ or ‘no,’ but ‘yes, with a plan’ — one that protects hydration, nutrition, muscle, vision, and safety during medical care.

The post GLP‑1 Medications in Later Life: Why the “Miracle Shot” Needs a Senior‑Specific Safety Lens appeared first on Medika Life.

In addition to obesity, a growing number of people around the world are struggling with substance use disorders, tobacco use disorders, and alcohol use disorders. Everyone, from the person experiencing the disorder to their loved ones and the community at large, feels the effects of these conditions.

The co-existing disorder data indicate many patients are engaging in multiple substance use, which significantly raises the dangers linked to each substance individually. But there’s also another factor: discrimination. Experiencing both obesity and discrimination can contribute to mental health problems, leading some to rely on substances for relief.

Consider, for a minute, who the primary targets are for advertising substances, such as alcohol and cigarettes. I suspect you will note that it is in communities with lower socioeconomic levels and higher rates of discrimination.

Medication to the Rescue?

Medications for alcohol use disorder, opioid use disorder, cocaine use disorder, and tobacco use disorder may not be as effective as we need. Recent findings suggest targeting GLP-1 receptors as a potential approach for developing new pharmaceutical therapies for many disorders besides obesity. How might they work?

The small intestine produces GLP-1 upon food consumption, and the brain also produces it and releases it as a neurotransmitter in several brain regions. Importantly, GLP-1 can cross the blood-brain barrier (the brain’s biological moat) and reach receptors in areas associated with the neurobiology of addiction.

These new GLP-1 drugs are assuredly affecting something that may drive obesity—junk food. Junk food may play a significant role in obesity, and the new medications meant to curb our taste for it are cutting into junk food profits. But the desire for junk food starts early, and many factors are associated with it.

Three reasons for junk food preferences may be present: lack of money leads to purchasing cheaper foods, one behavioral element, and one lifestyle element. The lifestyle element may have more to do with the demands of work and a lack of time for food preparation. But why do we crave junk food? Some experts believe it’s a learned response from infancy. We have an industrial palate.

The “industrial palate” is a taste preference for processed foods developed from early exposure in infancy and characterized by artificial ingredients. What’s in baby foods, and do you recognize all the ingredients? Oddly, it echoes the expression, “Give me a child before the age of seven, and they are mine for life.”

Some people on GLP-1 medications have found that they no longer crave ultraprocessed foods. What is in these foods? They contain chemicals, such as artificial sweeteners, colors, bleaches, and modified starches, are not normally seen in a home kitchen.

Don’t you want bleach in your food anymore? (Side note: They bleach maraschino cherries before dyeing them red.) There may be several solutions for all of that, and it is problematic for industries built on keeping your palate leaning in their direction.

Food Choice and Obesity Medications

The GLP-1 medications may affect the reward center in our brains, but how do they specifically affect junk foods?

The main point is that the glucagon-like peptide-1 (GLP-1) system in the brain is very important for controlling how much food you eat and your weight. The study focuses on the differences between GLP-1 that comes from the gut and GLP-1 that comes from the brain, and how these differences affect the effects of drugs that bind to GLP-1 receptors and are used to treat obesity. It also shows that targeting the GLP-1 system in the brain could open up new ways to treat obesity.

There is a simpler way to state this interaction and the biology behind why these new drugs work. GLP-1 is secreted in the small intestine and aids in maintaining stable blood glucose levels, decreasing hunger, and delaying stomach emptying. As a possible treatment for addiction, GLP-1 receptor agonists have garnered interest via animal studies.

Preclinical research in mouse models has demonstrated that GLP-1 receptor agonists can reduce the rewarding and reinforcing effects of certain addictive substances, alcohol consumption, and seeking behaviors. We do not yet know how activation of GLP-1 receptors affects alcohol and drug effects, although it might have something to do with regulating the dopamine and stress systems, among other neurotransmitter systems.

Technology Enters the Mix

If our current economy demands workers have little time for shopping and food preparation, how might technological advances in food preparation affect the purchase of ultraprocessed food? Hot pots and countertop devices are gaining popularity with consumers and prices for them are coming down as their intended uses increase with advanced design.

In competing with food technology devices, corporations that are engaged in the production of fast or junk foods have research teams currently producing lines of weight-maintaining or weight-loss meals. These meals are designed to temper upward their attractiveness in a variety of ways, one of which is in the naming of the products. They are now being called products that are “weight conscious” or “high protein” or to be used in conjunction with weight reduction medication.

Consumers must decide whether fast food fits their lifestyle, despite potential health consequences and cost. The research on the GLP-1 receptors, however, offers promise in substance abuse disorders, and, therefore, in life-maintaining methods. The medication’s will not be limited to obesity alone and will find a welcoming field in healthcare providers where addiction has proven to be difficult for many.

The post Is Junk Food Biz Fighting Back Against Weight Loss Drugs or Accepting Them? appeared first on Medika Life.

Thanks to viral social media posts and constant press coverage, Ozempic and Wegovy have become almost household names, and many primary care providers face questions — some based on social media misinformation — from patients eager to give these new medications a try. The following are common questions I’m asked, and suggested context to frame a response.

• “Can you write me a prescription for Wegovy?”

Patients should understand that it’s not just a matter of writing a prescription. Obesity is a complex, chronic disease, and many interrelated factors, including genetics, environment, sleep patterns, stress, medications, hormonal imbalances, and other health conditions, need to be considered to determine the best treatment. Wegovy isn’t suitable for everyone who has obesity; there may be other, more appropriate medications. It’s also important to provide education and ongoing support for sustainable dietary, physical activity, and behavior changes. Lifestyle interventions are rarely sufficient on their own, but they’re always essential components of any effective weight management plan. A successful weight loss strategy needs to address all these factors comprehensively and in a personalized way as part of a long-term care plan. There’s no quick fix for obesity.

• “I don’t want to resort to medication. It feels like cheating. Why won’t diet and exercise work for me?”

Most people with obesity cannot lose significant weight and keep it off long-term with lifestyle changes alone. This is because weight loss triggers the body’s physiological “anti-starvation” mechanisms, leading to increased hunger and cravings and a lower metabolic rate. With obesity, the area around the hypothalamus (the energy regulatory center in the brain) becomes inflamed, interfering with feedback signals from the gut and fat cells. Anti-obesity medications address these underlying dysregulated hormonal and metabolic pathways. Semaglutide, for example, mimics the GLP-1 hormone, which helps people feel full sooner after eating and slows the passage of food through the gastrointestinal tract. It targets areas of the brain that control appetite and influence eating decisions. Other anti-obesity medications work differently, but they all help the body overcome its anti-starvation responses to enable weight loss and weight maintenance.

• “Are the horror stories about Ozempic’s side effects — abdominal pain, constipation, diarrhea, and vomiting — typical? I don’t want to feel miserable.”

These are known adverse events associated with semaglutide, and it’s to be expected that as more and more people take these medications, we hear more about the side effects, including the rare ones. Symptoms may be worse when the medication is not used appropriately — if the dose is too high or it’s escalated too quickly, if the medication is prescribed without adequate screening (for example, to identify people who have risk factors for these symptoms), or if patients aren’t given the necessary education and support (dietary and behavioral modifications can minimize symptoms). When best practices are followed, patients generally tolerate semaglutide well.

There’s a risk-benefit calculation when prescribing any medication, of course, but for people with a high BMI, who face elevated risk of many serious weight-related conditions, the benefits may outweigh the risks.

• “What about aesthetic changes? I’ve heard about ‘Ozempic face.’ Will my skin get saggy?”

Loose skin is common with major weight loss, regardless of how it’s achieved, especially if the weight is lost rapidly. But this aftereffect is highly variable, with age, diet, and genetics among the factors that play a role. Some people lose 100 pounds and have no loose skin, and others develop a significant amount of loose skin after losing much less weight.

It’s important to note that weight reduction involves the loss of muscle as well as fat, so I always recommend and regularly encourage  patients to incorporate strength training into their weight management program in order to maintain as much lean body mass as possible.

• “How long will I need to take Wegovy?”

Patients should expect to take the medication for the foreseeable future. Obesity is a chronic disease., We don’t counsel patients with other chronic illnesses about weaning medications once their condition is controlled. When a person with diabetes stops taking an antidiabetic medication, we expect blood sugar to increase. And when someone with high blood pressure stops taking an antihypertensive medication, we expect blood pressure to rise. Obesity is the same. The FDA has approved these medications for long-term use for this reason. Weight gain isn’t just possible after stopping an anti-obesity medication discontinuation, it’s expected.

• “Why doesn’t my insurance cover Wegovy?”

For years, weight loss was considered strictly “cosmetic,” and obesity was attributed to individuals’ poor lifestyle choices. Today, most industry players — including insurers — recognize that obesity is a complex, chronic disease. But the new anti-obesity medications are extremely costly, especially considering the huge number of potential users (more than 42% of U.S. adults have obesity).

Access needs to improve, and it needs to improve dramatically, but simply handing out GLP-1 prescriptions left and right isn’t the answer either.

A comprehensive approach to weight management can improve health outcomes for more than 200 other conditions that obesity causes or worsens, from high blood pressure and type 2 diabetes to sleep apnea and certain types of cancer. It makes more sense — in terms of both patient health and economics — to treat the underlying obesity directly rather than waiting for these preventable obesity-related diseases to develop.

Now that we have a critical mass of patients taking these new, highly effective medications, we will have more comprehensive data demonstrating the mortality benefits of anti-obesity medications. For example, results from Novo Nordisk’s landmark SELECT trial, a five-year cardiovascular outcomes trial of Wegovy compared to placebo in individuals with overweight or obesity, recently found that semaglutide reduced the risk of major adverse cardiovascular events (heart attack, stroke, and cardiovascular deaths) by 20 percent. With this evidence from the SELECT trial, improved insurance coverage should be next.

• “If my insurance doesn’t cover semaglutide, are there alternatives?”

Semaglutide is an important part of our anti-obesity armamentarium, but we don’t automatically prescribe it to everyone who qualifies. Other options include Contrave, Saxenda, and Qsymia, for example. Any anti-obesity medication needs to be selected in the context of a comprehensive individualized evaluation and prescribed as part of a personalized treatment plan. Depending on a patient’s specific situation and risk factors, I prescribe many medications that are considerably less expensive than semaglutide, and individuals on these medications are still able to lose a significant amount of weight. Everyone’s situation is different, and individuals respond to different medications in different ways. Obesity is not a simple disease, and there’s no one medication that’s right for everyone.

• “What about supplements like berberine? Some people are calling it ‘nature’s Ozempic.’ Is it worth trying?”

I caution my patients about dietary supplements for weight management because we don’t have high-quality evidence demonstrating efficacy. Worse, the lack of regulatory oversight in the supplement market makes it challenging to know exactly what’s contained in any given product. The actual amount of berberine could be different from what’s claimed, and other undisclosed ingredients could be included as well. For example, some dietary supplements have been shown to contain amphetamines or anti-obesity medications that have been withdrawn from the market.

• “What about compounded semaglutide? Is it safe?”

When patients present to me on compounded semaglutide, I recommend that they stop. As with dietary supplements, these drugs are not regulated. We have no idea what the products contain, what the actual dose of the active ingredient is, or whether the product has contaminants. The FDA has issued a warning about compounded semaglutide.

• “I’m having surgery next month. Is it true that I need to suspend my Wegovy?”

Because GLP-1 receptor agonists are associated with increased risk of nausea, vomiting, and delayed gastric emptying, the American Society of Anesthesiologists recently issued guidance suggesting that individuals who take these medications daily should stop the medication the day of the surgery, or, if they take them weekly, hold the dose the week before surgery. People who are taking these medications for diabetes in addition to weight management may need to consult with their endocrinologist to identify an alternative diabetes medication to bridge the gap.

Wegovy and the other anti-obesity medications in the pipeline that are even more promising are and will be extremely important agents in our armamentarium, but successful weight management requires more than just one medication in isolation. Media coverage of these new medications sometimes creates the impression that obesity is a simple disease that can be treated with a one-size-fits-all, short-term approach. In reality, however, obesity is, a complex, multifactorial, relapsing chronic disease, and treating it requires a comprehensive evaluation and a customized treatment plan with education and long-term support.

The post Are Your Patients Asking about Wegovy? appeared first on Medika Life.

Managing disease has become the well trodden path to providing those profits.

To paint pharma as the only black sheep in the healthcare family would however be grossly unfair, as insurers and other Shylock’s have smelled the blood in the water and have been circling and feeding for decades. If we however, as patients, represent the fish in the water, pharma is guilty of providing the worms industry bait their hooks with.

How many people reading this article can open their medicine cabinet and produce one or more drug they have been prescribed in the last decade that comes with a repeat prescription – for life! I’d hazard it would be more than half the readers. Healthcare is no longer trying cure you, and probably stopped trying decades ago. Right around the time the penny dropped.

A healthy, cured cow is no longer a cash cow. Long term management became the new catchphrase of medicine.

A change in tack

The mechanics that underpin this shift in care are incredibly transparent and from a physiological point of view, also simpler to manage. It is far easier interfering on a daily basis with the production of, say, excess stomach acid in someone who suffers from gastritis, than it is to address and correct the underlying cause of the excess acid. I should know, I take a daily dose of Omeprazole for exactly this.

While the package insert suggests the medication should not be used for longer than 10 days (covering the manufacturer) some doctors prescribe these for life. Who, I wonder, when the dust settles in the industry, will be held legally liable for off-label use. I’d suggest to the prescribing doctors that it wont be the manufacturers.

Almost every drug we now manufacture falls prey to off-label use or use way beyond its intended, approved and clinically trialed, prescribed use.

Aspirin is ingested daily by millions around the globe in the hopes it will offer some form of protection against cardiac events and clotting. Statins are prescribed for life, to control bad cholesterol and soften your arteries. Ozempic, a drug containing semaglutide to manage insulin in diabetics is now being used off-label for weight management. To keep the weight off, you’re obliged to use it for life.

How does Ozempic affect a healthy patient population that does not suffer with diabetes? No one knows, as the long term use of the drug has not been tested in this patient population. Why would you bother? To be clear, the doctor signing your script doesn’t have a clue either. In the cold light of day, he is taking an unethical medical risk prescribing an off-label drug to you, one you may very well require for life.

We know, and your doctor is all to well aware of this, that exercise and a healthy diet can potentially replace most of the drugs you pay for each month. Drugs that are supposed to buy you the time to implement healthy changes in your lifestyle are now being used to chain you to the wheel of never ending “health” dependency.

An expensive habit, with drugs like Ozempic retailing for around $1500 a shot. The price has skyrocketed as vanity has boosted demand for the drug, leaving patients with actual diabetes, who have a real need for the medicine, unable to find or afford it.

So ingrained has this “continued use” policy become, in both the minds of healthcare and patients, that even the vaccines we now manufacture, are subject to it. Booster shot after booster shot.

Problems abound

There are of course multiple and often serious consequences of practicing medicine this way, a few of which are outlined in brief below;

• Off-label use in medications are very rarely subjected to clinical trial, so even the prescribing doctor is unsure of how your continued use of a particular medicine is going to impact your health.
• You place organs like your kidneys and liver at increased risk by taking large amounts of medication.
• Patients are often prescribed additional medication to counter the effects of existing medication. This additional medication, is, of course, also for life. Patients can end up with shelves of pills.
• Often expensive, these medications can, and do, drain the savings of many elderly patients.
• This pill mill places unnecessary demands on healthcare insurers who drive up premiums, an action that has a direct knock-on effect on the cost of care.

The topic is far too complex for a short article like this to explore in any depth, and I would highly recommend reading a series by Stephen Schimpff Md on Medika. The ten articles examine the issues in far more depth.

Stemming the tide

The problem of creating a medication dependent population can only be affectively addressed at its point of origin. The doctors consulting room. While doctors themselves are not to blame for the “management mentality” that pervades healthcare, they do act as the point of origin. They are also, much like they patients they treat, victims of the system.

Ridiculous time constraints and pressures brought to bear on doctors by insurers and the healthcare system they are obliged to operate within, all lead to one inevitable result. Quick in – quick out, with patients receiving only cursory care. Diagnosis suffers as a result. Patients are also conditioned to expect that leaving the consultation without a prescription in hand equates to poor treatment.

Both doctors and patients need to be re-educated on the primary goal of healthcare. It is to deliver care that prevents or cures disease and manages health. Drugs, in most instances, are temporary fixes to allow for healthy lifestyle choices to restore wellbeing. Our bodies are capable of reinvigorating themselves if the damage is identified early and the causes addressed.

Medicating someone up the yazoo and essentially turning them into prescription junkies does not improve quality of life. In point of fact, it often worsens it. As long as we continue to accept the current healthcare status quo, our health as a global population will continue to decline.

The post Forever Medicated is the Future of Healthcare appeared first on Medika Life.

How many physicians or prescribers have ever thought that there is an individual time of day for each person to take their medication? It’s not the number of hours between the doses but when the doses should be taken, and that is a matter of our individual circadian rhythms. How could that be determined?

The dawn of circadian rhythms in medicine is here and it’s not confined to sleep medicine, but to all of medicine where it applies, albeit there is a paucity of knowledge in medicine about its effects.

We now know that one research effort that looked at 106 clinical trials over 50 years found that 75% of the studies discovered treatment efficacy or toxicity was highly dependent on dosing time across a number of conditions which included hypertension, cancer, asthma and arthritis.

The number of medical conditions that would be affected by dosing and circadian rhythm is obviously not limited to these few disorders and, most probably, affect the whole of medicine and every single medical disorder.

To disregard this natural schedule is not practicing medicine effectively for the benefit of the patient. Scribbling out prescriptions without this important knowledge is like trying to keep chalk drawings on a sidewalk in a thunderstorm.

Our molecular clock runs on a 24-hour circadian rhythm in cardio, metabolic, endocrine, immunologic, and behavioral functions. This 24-hour clock has been questioned by sleep medicine experts who believe it is a bit more than that but less than a 25-hour clock.

More Than Sleep Hygiene

One aside note here about your sleep environment. You’ve heard about keeping the room cool, having blackout shades or heavy window coverings, but that’s part of sleep hygiene, not what I’m addressing.

ANY amount of light in the room while you sleep is disruptive to possibly ALL of those multiple body clocks that run your entire body. We’re not concentrating here on daytime sleepiness or alertness while you work.

It doesn’t matter if it’s a night light, a TV screen, an illuminated alarm clock, the light on a computer surge protector — anything is disruptive. What might you do? Consider whether a sleep mask would be an idea to make a part of your sleep preparation.

Besides the consideration of eliminating light as you sleep, is there a specific dosing time of day for medications? Researchers indicated that “only four out of the 50 currently most prescribed drugs have FDA labeled time-of-day dosing recommendations,” and (WHO) the world health organization’s list of essential medicines, does not mention dosing time.

It is more than curious that while some experts are considering dosing time important, others fail to recognize it. Maybe they never heard about it in medical school, but don’t they have an obligation to keep up with the research, and doesn’t the FDA and the pharmaceutical firms bear some responsibility here, too? The question of circadian regulation has been addressed, and there is a belief that every peripheral tissue in mammals has a local clock for that specific tissue.

Of course, this tissue issue makes medication dosing and timing for patients important and difficult unless we have a universal timetable from which to extract the optimum time for each individual’s medication dosing. A brain component of the hypothalamus is the central switching station, but each “clock” still has to synchronize to it. Computers and algorithms would seem to be the way to solve this dilemma, and yet I have failed to find anything that has offered that solution.

Whether you should be taking your cholesterol medication in the morning, at noon or afternoon is an important issue. It’s the same with every medication you take, with the possible exception of insulin that is required to keep glucose levels within certain parameters no matter the time of the day. Suppose cancer medications would be most effective at noon rather than in the morning, but they’re still given in the morning, wouldn’t that make a difference in your health?

Is the lack of consideration of optimal dosing time of day reducing a medication’s potential to remediate some disorder? The science suggests that is exactly the case.

The post Is There an Effective Time of Day to Take Your Medication or Not? appeared first on Medika Life.

Medicine is not only a science; it is also an art. It does not consist of compounding pills and plasters; it deals with the very processes of life, which must be understood before they may be guided. — Paracelsus

Humans are prone to illness and disease; there is no doubt, but how these illnesses are treated is often misunderstood. Patients are thankful that there are medications today that were once mere far-fetched dreams in the minds of scientists. We not only have medicines, but we have medical procedures that save lives. Even here, there is no infallibility.

Research has pulled us from death’s door with medical alchemy, but there is no free lunch in medicine, either. Every medication, every procedure, comes with its share of side effects or dangers, some of which are missed by the most acute eyes.

I once had the good fortune to work with a well-known oncologist. A patient was being discharged from his hospital and he happened to be nearby. “What did you find?” he asked. “Nothing,” was the reply. The elder doc scratched his head and asked, “Did you look under his tongue?” They hadn’t.

A quick look and his cancer was discovered in a good-sized tumor under his tongue.

Another physician I’ve known for over three decades once expressed a great degree of reluctance to prescribe antibiotics. “Do you want to take poison,” he asked his patient. Poison?

Whoever thought of any antibiotic medication as something that could kill? It may not kill you unless you are allergic, but its purpose is to kill something.

In rare cases, an antibiotic can cause a severe and potentially life-threatening allergic reaction known as anaphylaxis.

Medications do heal, but they can bring on symptoms that, if not carefully detailed, can be misunderstood to the detriment of the patient.

Psychiatric Side Effects of Some Medications

Under normal circumstances, our immune system is an efficient killing machine that seeks out bad actors in our body and swarms them to death. The call goes out quickly, but sometimes the illness is too much for them.

Natural killer (NK) cells are lymphocytes of the innate immune system that participate in early defense against foreign cells and autologous cells undergoing various forms of stress, such as microbial infection or tumor transformation.

When supportive medications are needed, they may lead to an iatrogenic illness, an illness caused by medical intervention. Prescribing can be especially serious in older patients who have several medical conditions.

Risk factors of iatrogenic disease in the elderly are drug-induced iatrogenic disease, multiple chronic diseases, multiple physicians, hospitalization, and medical or surgical procedures. Iatrogenic disease can have a great psychomotor impact and important social consequences.One of the consequences can be an apparent memory impairment.

These medication-induced behavioral manifestations may be seen as psychiatric syndromes and not medication-related and therein lies a problem. An inappropriate diagnosis results in even more, sometimes deleterious, prescriptions for these patients. For this reason, psychiatric and other medications contain black box warnings regarding prescribing for elderly patients since they may cause death.

Enter the Steroids

While not causing an iatrogenic illness, steroids that are a group of workhorses of medicine, are particularly problematic in older patients. As we age, our systems change, are not as efficient and we require specialized care.

Also, certain drugs have an especially high risk of adverse effects in the elderly, due to changes in body composition and drug metabolism. Specific examples include anticholinergics such as diphenydramine, benzodiazepines and other sleep aids (eg, zolpidem), opioids, antipsychotics, anticoagulants, and NSAIDs (see Beers criteria). Also included here should be prednisone and dexamethasone.

Steroid-induced psychosis is a well-documented phenomenon. Contrary to early thought, these symptoms are not very prevalent in populations with known psychological illnesses but rather it is a dose-dependent disorder that is more prevalent in people who have certain diseases or are on medications that will augment the effect of the steroids.

A review of some steroid-induced psychosis cases indicates that this disorder is not commonly seen. The belief is that it is underreported in the medical community because it is not severe enough, nor long-standing sufficiently to be reportable.

In one sample, 71% of the cases had steroid-induced psychosis, but 14% had no evidence of significant mood changes or delirium. However, depression was present in over 40% of the cases, 28% had mania, 7.5% showed mixed state mania and delirium in 10% of the cases.

Another study indicated that both mania and hypomania were commonly found in persons taking steroids and that this behavioral change was followed by depressive symptoms in 28%.

How long do the symptoms last? The answer is dependent on both the course of the illness that is being treated and the level of medication that is being prescribed. But it is believed that this diminished reality state (aka reality testing) may last anywhere from a few days up to three or more weeks.

Older Adults

In patients primarily adults, taking corticosteroids, common psychiatric changes which have been seen include euphoria, insomnia, mood swings, personality changes, severe depression, and psychosis in at least 5 to 18% of patients.

Depressive symptoms can last for about four weeks, while mania may persist for three weeks and delirium for a few days. Patients who have been on long-term glucocorticoid therapy may have both depression and delirium or confusion. The latter is more likely to be found in older adults, and anyone who is on a long-acting glucocorticoid is considered at risk.

In adult females, UTI (urinary tract infection) can present with mood disorders, delusions, hallucinations, agitation, and violent behavior. Would they order an antipsychotic medication for them? They might.

One symptom which is also seen in those who have been treated for a pulmonary disease is what is known as “steroid euphoria” which is characterized by reduced anxiety and depression even when there has been no improvement in lung function. “…some patients given oral corticosteroids develop a sense of wellbeing that is ‘inappropriate’ to improvements in physical health…but, unlike steroid-induced psychosis, it has not been documented.”

Psychiatric Symptoms of Steroids in Children

The side effects of steroid medications have been well-studied in adults, but not sufficient research has been reported in children. They experience the side effects, and the behavioral changes may not resolve once the treatment is stopped.

In pediatric patients with acute lymphoblastic leukemia, corticosteroid use appears to correlate with negative psychiatric and behavioral effects. In children treated with corticosteroids for noncancer conditions, adverse effects have been observed both during treatment and after cessation, although the data from article to article are not consistent enough to establish dose relationships.

Medications Other Than Steroids

Several medications may produce disturbances of reality testing or emotional dysfunction. A review of medications and their side effects, as well as the rare ones, can be found in Prescriber’s Digital Reference as well as Physicians’ Desk Reference for Herbal Medicines and a listing of resources maintained by the FDA.

Drugs that may lead to depressive, anxious, or psychotic syndromes include corticosteroids, isotretinoin, levo-dopar mefloquine, interferon-a, and anabolic steroids, as well as some over-the-counter medications.

In elderly patients, common antihistamines can cause visual hallucinations, a highly unusual symptom in psychiatric patients.

Older adults are especially sensitive to the central nervous system- and anticholinergic-related side effects of sedating antihistamines because of decreased cholinergic neurons or receptors in the brain, reduced hepatic and renal function, and increased blood-brain permeability. These patients also often have coexisting conditions and often take multiple medications that increase the risk of drug-drug interactions and the potential for sedative adverse effects.

Are any medications without side effects? The answer is “no,” and it is often a trade-off regarding the desired results and the possibility of uncomfortable or dangerous side effects. Both the prescriber and the patient must act in concert with each other to make these individual decisions.

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