Many non-prescription drugs are usually not covered by the government drug plans. However, residents of long term care facilities in Ontario are able to take specific non-prescription drugs at no cost to them. They are known as the “government stock” and contain mostly over-the-counter items designed to help nursing home residents to manage minor ailments.
I am not sure if anyone has taken a good look at the list. I certainly hope the list gets a review soon. Not only are the items quite outdated, some are listed on the BEERS criteria as inappropriate for the elderly population. For example, diphenhydramine (Benadryl) and dimenhydrinate (Gravol) are considered drugs with heavy anticholinergic properties and are strongly discouraged in this population. You can read about one reason why here. Yet they are available freely and without much constraint to nursing home residents. They may be free but in my opinion, they can be totally toxic or useless.
Here are few of my humble thoughts on this list of freebies:
- Instead of Antacids, add a H2 Antagonist: Get rid of the antacids that contain aluminum and magnesium. Either they are to be avoided in renal impairment or there are some concerns how they may be linked to dementia. These antacids can also contribute to constipation if overused. Instead, I wish they can add a low dose H2 antagonist such as ranitidine and famotodine. If there are occasional GI reflux issues, these are more effective than the good old antacids which don’t work well, have concerns with side effects (e.g. constipation, possible accumulation in renal impairment) as well as drug interactions (e.g. reduce absorption of many medications)
- Instead of Multivitamin, add Vitamin D and Vitamin B12 oral supplement: Sometimes when an elderly is not eating well, we suspect they may be malnourished and as such, we may want to supplement with a multivitamin tablet to ensure they are still receiving all the essential minerals and vitamins. I think the multivitamin just add to the pill burden without having some established benefits that they help to prevent malnutrition. Instead, I wish we can add Vitamin D and oral Vitamin B12 to the list. At least with Vitamin D, it may help to optimize bone health and improve muscle strength to hopefully prevent falls and fractures. And with Vitamin B12 oral tablet, we know now that we don’t have to worry about poor oral absorption. Many elderly residents may have low Vitamin B12 level that can either contribute to poor cognition or neuropathy.
- Instead of Docusate sodium and Milk of Magnesia, add Lactulose and PEG3360. Constipation is a common problem in the elderly. I am not a big fan of docusate sodium and here’s my reason. I don’t like Milk of Magnesia because it can accumulate in renal impairment. But Lactulose works well. I love PEG3360 (also known as Miralax or Restorolax) because it works really well to improve bowel care even for people who have very challenging bowel issues such as those with Parkinson’s disease and Multiple Sclerosis.
Yes some of these items may be a little bit more expensive but cost depends on your perspective too. The Gravol may be free but it can cost you in other ways. A resident may fall as a result of its sedating and anticholinergic side effects and results in reduced mobility that leads to the need of a mobility device. The antacids may be free but what good do they offer if they don’t work well, may mask other underlying conditions (e.g. angina) and reduce absorption of other drugs, leading to poor management of the resident’s other chronic conditions.
These non-prescription drugs may be “free” but costly in other ways. I wish someone will review and improve on this list and ensure items on the list are appropriate for the nursing home residents.