Key takeaways:
Older adults tend to experience medication side effects more often than younger people. There are many reasons for this, including natural body changes and medical conditions that typically develop over time.
The American Geriatrics Society maintains a list of medications that may be risky for older adults. Common examples are benzodiazepines and fluoroquinolone antibiotics.
Side effects that may happen more frequently in older adults include muscle pain from statins, thinking changes from sedative medications, and more.
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No matter how many years of life you’ve lived, medication side effects are never a welcome experience. But if you or a loved one have been around for a while, certain medications are more likely to cause side effects that interrupt one’s daily routine.
Some of these side effects are mild and manageable, like stomach pain and feeling weak. Other side effects can lead to more serious consequences, such as coordination changes that increase the risk of a fall.
Several medications can cause side effects like these, so it’s important to keep them in mind. These medications aren’t bad, but they happen to carry some well-known downsides — especially in adults ages 65 and older. Seven of the most notable side effects are highlighted below.
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1. Muscle pain and weakness
Muscle pain, or myopathy, has been reported in up to 25% of people taking statins. A class of medications used to treat high cholesterol, top statins include medications like simvastatin (Zocor), atorvastatin (Lipitor), and rosuvastatin (Crestor). Older adults often use these medications. In the U.S. and Canada, they’re among the most prescribed medications for people ages 60 to 79.
Muscle pain from statins doesn’t happen to everyone, but when it does, its severity can range from mild to severe. And while it can happen to anyone, the risk is slightly higher for older adults.
For most people, muscle pain goes away when you stop taking your statin. But your healthcare provider may consider restarting it at a lower dose or trying a different statin if you still need its cholesterol-lowering benefits.
2. Weaker bones
Proton pump inhibitors (PPIs) are popular medications for acid reflux and heartburn. These medications are among the top five most commonly used medications by older adults. They include medications like omeprazole (Prilosec), esomeprazole (Nexium), and pantoprazole (Protonix).
Among other things, PPIs can reduce the amount of calcium that your body absorbs from food. Over time, this can affect your bone health. PPIs have been linked to bone loss and bone fractures. This side effect can happen to anyone, but there’s an added risk for older adults.
In general, PPIs shouldn’t be used long-term without the OK from your healthcare provider.
3. High potassium levels
Many medications can increase the amount of potassium in your blood. Although our bodies need a certain amount of potassium to function, too much potassium (hyperkalemia) can cause potentially serious complications. This can include muscle weakness or dangerous changes in heart rhythm. No visible symptoms at all are also possible. Hyperkalemia is more likely to happen in people over 65 due to health conditions that can compile over time.
Some examples of medications that cause hyperkalemia are:
Sulfamethoxazole/trimethoprim (Bactrim)
Angiotensin-converting enzyme (ACE) inhibitors like lisinopril (Zestril)
Angiotensin II receptor blockers (ARBs) like losartan (Cozaar)
If you’re taking one or more medications that affect potassium levels, your healthcare provider may want to monitor your potassium levels over time.
4. Nerve pain
Nerve pain (peripheral neuropathy) is a common condition among older adults. Although many health conditions can contribute to it, some medications can do it too.
Nerve pain is a possible side effect of types of antibiotics called fluoroquinolones. These include medications like levofloxacin and ciprofloxacin (Cipro). Nerve damage is a side effect that can cause pain and difficulty moving and last from months to years. In some cases, it can be permanent.
Adults ages 60 and older are at an increased risk of this side effect. Make sure your healthcare provider and pharmacist know if you have a history of nerve pain.
5. Falls and delirium
Zolpidem (Ambien) is a popular medication used for sleep. But it increases the risk of falls, difficulty thinking, and motor vehicle crashes. This is especially true for people ages 65 and older.
Zolpidem belongs to a group of drugs known as Z-drugs. This class of medications also includes eszopiclone (Lunesta) and zaleplon (Sonata). None of these medications are recommended for regular use by older adults.
This is also true for a large group of anti-anxiety medications called benzodiazepines. Common examples include clonazepam (Klonopin), diazepam (Valium), and alprazolam (Xanax).
6. Heart, kidney, and gastrointestinal problems
Nonsteroidal anti-inflammatory drugs (NSAIDs) include medications like ibuprofen (Motrin, Advil), naproxen (Aleve, Naprosyn), and aspirin. They offer support for pain and inflammation, but they can increase the risk of heart problems, kidney issues, and stomach bleeding in people who take them. These risks appear to be higher for older adults.
If possible, try to avoid daily use of NSAIDs. If an NSAID is necessary for pain relief, ask your healthcare provider if occasional doses are safe for you to take.
7. Joint pain
Certain Type 2 diabetes medications — dipeptidyl peptidase 4 (DPP-4) inhibitors — are common treatment options for older adults living with diabetes. They include medications like sitagliptin (Januvia), linagliptin (Tradjenta), and saxagliptin (Onglyza). They only need to be taken once daily, and they don’t usually cause low blood sugar (hypoglycemia) or changes in body weight.
However, in 2015, the FDA issued an official warning about a risk for severe and disabling joint pain with DPP-4 inhibitors. This is important for people over 65 because joint-related issues are more likely to happen in older adults.
Let your healthcare provider know if you develop new or worsening joint pain while taking medications like Januvia.
Antibiotic side effects to keep in mind
Antibiotics are a large group of medications that fight bacterial infections. And while they’re often life-saving medications, many of them share some common side effects. These side effects may affect anyone, but older adults tend to be more sensitive to them.
| Antibiotic group | Examples | Common side effects |
|---|---|---|
| Most antibiotics | Cephalexin Azithromycin (Zithromax) Metronidazole (Flagyl) |
|
| Penicillins | Penicillin (Penicillin VK) Amoxicillin |
|
| Tetracyclines | Tetracycline Doxycycline (Vibramycin) Minocycline (Minocin) |
|
Why are older adults more sensitive to medications?
Sensitivity to medications is caused by many factors, including age. As you grow older, small changes in your body affect how medications behave. This can be due to changes in how the heart, liver, and kidneys work. These organs tend to affect how medications are processed and metabolized by your body. For example, if the kidneys remove a medication more slowly from the body, its effects will last for a longer time. This can raise the risk of side effects.
Getting older comes with many other life changes. Unfortunately, compiling medical conditions is often one such example. Because of this, you may be taking more medications than you previously have. And as you take more medications, there’s a higher risk for these medications to alter how the others work. When this happens, it’s known as a drug interaction, and it changes how your body reacts to medications.
How common are medication side effects in older adults?
Due to the changes in how bodies work as they age, older adults are at a higher risk for medication side effects than younger people. In fact, adults over 65 are twice as likely to go to the hospital for medication-related side effects than younger adults.
The good news is that more than half of hospital visits related to medication side effects are preventable. If you notice any new side effects or symptoms that are bothering you, make sure to let your healthcare provider know. They can offer management tips before anything becomes severe.
What is the Beers List, and why is it relevant for older adults?
The American Geriatrics Society (AGS) keeps track of medications that may have unnecessary risks for older adults. Their list of medications is called the AGS Beers List. This list has one goal — keeping people over 65 safe, healthy, and happy for years to come.
In addition to medications listed above, some common medications that appear on the AGS Beers List include:
Diphenhydramine (Benadryl)
Cyclobenzaprine (Amrix)
Glimepiride (Amaryl) and glyburide (Diabeta, Glynase)
Desmopressin (Nocdurna)
It’s always good to prevent side effects before they happen. Make sure to ask your pharmacist if any of your medications or supplements are on the AGS Beers List.
The bottom line
Older adults have a higher risk of experiencing medication-related side effects than younger people. However, specific side effects vary by medication.
If you or a loved one is experiencing side effects from a medication, make sure to reach out to a pharmacist or healthcare provider. They can offer management tips to help get the benefits and reduce the risks of using medications.
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References
American Geriatrics Society Beers Criteria Update Expert Panel. (2019). American Geriatrics Society 2019 Updated AGS Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society.
Beckett, C. L., et al. (2015). Special considerations of antibiotic prescription in the geriatric population. Clinical Microbiology and Infection.
Centers for Disease Control and Prevention. (2019). Prescription drug use among adults aged 40–79 in the United States and Canada.
Davies, M., et al. (2022). Management of hyperglycemia in Type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care.
Hicks, C. W., et al. (2021). Prevalence of peripheral neuropathy defined by monofilament insensitivity in middle-aged and older adults in two US cohorts. Scientific Reports.
Iwere, R. B., et al. (2015). Myopathy in older people receiving statin therapy: A systematic review and meta-analysis. British Journal of Clinical Pharmacology.
Kumar, R., et al. (2017). Managing hyperkalemia in high-risk patients in long-term care. The American Journal of Managed Care.
Lavan, A. H., et al. (2016). Predicting risk of adverse drug reactions in older adults. Therapeutic Advances in Drug Safety.
Maes, M. L., et al. (2017). Adverse effects of proton-pump inhibitor use in older adults: A review of the evidence. Therapeutic Advances in Drug Safety.
Merel, S. E., et al. (2017). Common drug side effects and drug-drug interactions in elderly adults in primary care. Journal of the American Geriatric Society.
Mohsen, S., et al. (2020). Update on the adverse effects of antimicrobial therapies in community practice. Canadian Family Physician.
Morales, D., et al. (2019). Association between peripheral neuropathy and exposure to oral fluoroquinolone or amoxicillin-clavulanate therapy. JAMA Neurology.
U.S. Food and Drug Administration. (2013). FDA Drug Safety Communication: FDA requires label changes to warn of risk for possibly permanent nerve damage from antibacterial fluoroquinolone drugs taken by mouth or by injection.
U.S. Food and Drug Administration. (2015). FDA Drug Safety Communication: FDA warns that DPP-4 inhibitors for type 2 diabetes may cause severe joint pain.
U.S. Food and Drug Administration. (2018). FDA Drug Safety Communication: FDA updates warnings for oral and injectable fluoroquinolone antibiotics due to disabling side effects.
Wongrakpanich, S., et al. (2018). A comprehensive review of non-steroidal anti-inflammatory drug use in the elderly. Aging and Disease.
Yibirin, M., et al. (2021). Adverse effects associated with proton pump inhibitor use. Cureus.
