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Short Summary
Main recommendation: Adults over 65 should be cautious with five commonly prescribed medicines and consider lifestyle changes or alternatives, since Dr. Eric Westman says these drugs frequently cause serious side effects in older patients. The five medicines are hydrochlorothiazide, gabapentin, high-dose NSAIDs, Flexeril (cyclobenzaprine), and Benadryl (diphenhydramine).
Key Points
- The five medicines Dr. Westman flags for people over 65: (1) hydrochlorothiazide, (2) gabapentin, (3) high-dose NSAIDs such as ibuprofen, naproxen, and diclofenac, (4) Flexeril (cyclobenzaprine), and (5) Benadryl (diphenhydramine).
- Hydrochlorothiazide can cause dehydration and low potassium (hypokalemia); Dr. Dant (whose video Westman reviews) says he has seen hospitalized patients over 65 with potassium often under 3.0 (sometimes 2.9, 2.8, or lower), with 3.5 considered the normal minimum.
- Gabapentin (Neurontin), according to Dr. Dant and Dr. Westman, can cause drowsiness, dependence leading to dose increases, and weight gain, which they say may raise fall and fainting risk in older adults.
- NSAIDs, Dr. Dant says, at high doses over long periods can damage the stomach lining, cause ulcers or bleeding, and impair kidney function based on cases he's seen.
- Flexeril and Benadryl, Dr. Dant and Dr. Westman say, can cause oversedation, which they've seen associated with falls in people over 65.
Details Worth Noting
- Concrete instructions: If you take hydrochlorothiazide, discuss with your doctor a lifestyle change (such as a low-carb or keto diet, which he says can lower blood pressure, especially with weight loss) and whether a different blood pressure medicine could replace it. Do not assume bananas or potassium foods fix low potassium on a low-carb diet; he suggests leaning on vegetables and greens while avoiding the drug if possible. For Flexeril, consider asking about root causes such as low magnesium, and explore lifestyle changes instead of drug treatment. For itching or rash, ask about a nonsedating antihistamine rather than Benadryl. Look for practitioners through the Society of Metabolic Health Practitioners (smhp.org) or the Obesity Medicine Association.
- Hydrochlorothiazide is inexpensive and often used as a first-line blood pressure drug, while he prefers lifestyle treatment first; diagnosis typically involves repeated measurements over months before medication.
- Gabapentin starts around 100 mg two or three times a day, and he has seen patients on 600 to 900 mg multiple times daily; sudden drowsiness after cutting back may signal over-sedation.
- He notes that medications like steroids (including fluticasone nasal spray, prednisone, and insulin) can also cause weight gain, which is worth reviewing if weight is a concern.
- He also mentions that keto-style diets have been used by some pain specialists to help patients reduce opioid use and chronic pain.
Bottom Line
Many common medicines carry risks that intensify with age, so older adults should ask their doctors about side effects and about lifestyle or alternative options before continuing them.
