Managing Side Effects of Medications in Elderly Patients: A Case Study

Suspected side effects after medication use?

Hello Doctor: My father is 74 years old and has a history of stage III lymphoma (he completed second-line chemotherapy in February last year and is currently under follow-up).
He has normal-tension glaucoma and his vision has been deteriorating.
Recently, we started him on Circulin to stimulate the circulation of his peripheral optic nerves in hopes of slowing down the deterioration.
As of today, he has been taking Circulin for two weeks, three times a day (one tablet each in the morning, afternoon, and evening).
In the past few days, we noticed that he has developed large areas of rashes on his body.
Yesterday, he suddenly reported feeling dizzy and on the verge of fainting.
We checked the instructions for Circulin, which state, "If a skin allergic reaction occurs: such as erythema, rash, edema, itching, or systemic allergic reactions such as anaphylactic shock: fainting, loss of consciousness, please stop taking it immediately and seek medical attention." Currently, my father is following his doctor's advice and is taking the following medications: a lipid-lowering medication, Rosuvastatin, every other day, as well as allergy and immunology medications—Roflumilast, Cetirizine, and Sertraline (due to his Sjögren's syndrome).
Additionally, he is taking some dietary supplements.
Doctor, should we stop Circulin immediately and take him to the hospital, or can we reduce the dosage? If he needs to see a doctor, should we consult an allergist or rheumatologist? Thank you for your response, and I appreciate your help!

Ms. Li, 40~49 year old female. Ask Date: 2018/12/07

Dr. Cai Dongqi reply Family Medicine

Hello, if your father has a generalized rash, it may be caused by medication.
It is recommended to stop the medication and consult a dermatologist.

Reply Date: 2018/12/07

More Info

Managing side effects of medications in elderly patients is a critical aspect of healthcare, especially considering the complexities that arise from polypharmacy and the unique physiological changes that occur with aging. In your father's case, the emergence of a significant rash and dizziness after starting a new medication, Circulin (循利寧), raises important concerns that need to be addressed promptly.

First and foremost, it is essential to recognize that elderly patients often have heightened sensitivity to medications due to factors such as decreased renal and hepatic function, altered body composition, and the presence of multiple comorbidities. This can lead to an increased risk of adverse drug reactions (ADRs). In your father's situation, the development of a rash and dizziness could indicate an allergic reaction or an idiosyncratic response to Circulin. The product information you referenced clearly states that if any allergic reactions occur, including skin reactions or systemic symptoms like dizziness, the medication should be discontinued immediately, and medical attention should be sought.

Given these considerations, it is advisable to stop the use of Circulin immediately. Continuing the medication could exacerbate the symptoms and lead to more severe reactions, such as anaphylaxis, which is a medical emergency. It is crucial to prioritize your father's safety and well-being.
Regarding the next steps, your father should be evaluated by a healthcare professional as soon as possible. Given his symptoms, it would be appropriate to consult with a physician who specializes in allergy and immunology, as they can assess the rash and dizziness in the context of his overall health and medication regimen. If there are concerns about the potential for a severe allergic reaction, it may also be prudent to visit an emergency department, especially if symptoms worsen.

In addition to addressing the immediate concerns regarding Circulin, it is also important to review your father's entire medication list with his healthcare provider. This includes the cholesterol-lowering medication (冠脂妥), the allergy medications (柔它錠, 配你安, 安思平), and any supplements he may be taking. Drug interactions or cumulative side effects from multiple medications can sometimes contribute to adverse reactions, and a comprehensive medication review can help identify any potential issues.

Lastly, it is worth noting that managing side effects in elderly patients often involves a multidisciplinary approach. Involving pharmacists, geriatricians, and other specialists can provide a more holistic view of your father's health and medication management. They can help tailor his treatment plan to minimize side effects while effectively managing his underlying conditions, such as glaucoma and any other health issues he may have.

In conclusion, stop Circulin immediately, seek medical attention for your father's symptoms, and consider a comprehensive review of all his medications with his healthcare provider. This proactive approach will help ensure his safety and optimize his treatment plan moving forward.

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