Should an older adult stop one of these medicines immediately?

No. Do not stop or change a prescription on your own. Some medicines need a planned review, and sudden changes can create new risks. Bring the full medicine list to a doctor, pharmacist, or qualified health professional.

Are over-the-counter pain relievers safer because they do not require a prescription?

Not automatically. NSAID pain relievers can carry cardiovascular, kidney, blood pressure, and bleeding concerns, especially in older adults or people with heart disease, prior stroke, kidney problems, or several medicines.

Why are cold medicines a concern for people with high blood pressure?

Some decongestants narrow blood vessels. That may help nasal stuffiness, but it can also raise blood pressure or make blood pressure harder to control. A pharmacist can help identify products without those ingredients.

What should families ask about antipsychotics in dementia care?

Ask what symptom the medicine is meant to address, what non-drug steps have been tried, what benefit would count as success, what side effects should be watched for, and when the medicine will be reassessed.

How often should older adults review their medicines?

A review is useful at least yearly and sooner after a hospital visit, new diagnosis, fall, blood pressure change, memory change, new prescription, or repeated use of over-the-counter pain or cold medicines.

5 Medicines Older Adults Should Review for Heart and Stroke Risk

Older adult reviewing medicine bottles beside a blood pressure cuff and notebook | lilicooks.com

Some medicines can make heart attack or stroke risk more complicated for older adults, especially when a person already has high blood pressure, heart disease, prior stroke, kidney problems, dementia, or several prescriptions. The five groups most worth reviewing are non-aspirin NSAID pain relievers, oral decongestants, systemic menopausal hormone therapy, antipsychotics used for dementia-related symptoms, and triptan migraine medicines in people with cardiovascular risk factors. This does not mean these medicines are always wrong. It means the risk-benefit conversation needs to be specific, current, and personal. A medication that is reasonable for one person may be poorly matched for another person with different health history, frailty, or other medicines.

Why medication risk changes with age

Older adults are more likely to have baseline cardiovascular risk factors, and many take several prescription and nonprescription products at the same time. That matters because medication warnings are rarely about a pill in isolation. They are about the person taking it: blood pressure, kidney function, prior heart attack or stroke, bleeding risk, dementia status, and the reason the medicine was started. The 2023 American Geriatrics Society Beers Criteria describe several medicines that may be inappropriate or need caution in adults 65 and older, while also stressing that the criteria should support shared clinical decision-making rather than replace it https://pmc.ncbi.nlm.nih.gov/articles/PMC12478568/.

Organized medication review items arranged on a table | lilicooks.com

The five medication groups at a glance

A useful medication review is not a hunt for a single “bad” pill. It is a structured check of common risk points. Bring prescription bottles, over-the-counter products, patches, inhalers, supplements, and pharmacy printouts to the same conversation. Ask why each medicine is still needed, what risk it carries for your situation, and what symptoms should lead to urgent care.

Non-aspirin NSAIDs: ibuprofen, naproxen, diclofenac, meloxicam, celecoxib, and related pain relievers.
Oral decongestants: pseudoephedrine, phenylephrine, and similar cold or sinus ingredients.
Systemic menopausal hormone therapy: estrogen with or without progestin taken by mouth or delivered through the skin.
Antipsychotics in dementia-related symptoms: risperidone and related medicines when used in older adults with dementia-related psychosis or severe agitation.
Triptan migraine medicines: sumatriptan and related medicines in people with heart disease, prior stroke, uncontrolled blood pressure, or multiple cardiovascular risk factors.

1. Non-aspirin NSAID pain relievers

Non-aspirin NSAIDs are widely used for arthritis, back pain, headaches, and other painful conditions. FDA-approved labeling for meloxicam, one NSAID example, warns that NSAIDs may increase the risk of serious cardiovascular thrombotic events, including myocardial infarction and stroke, and that people with cardiovascular disease or risk factors may be at greater risk https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=f8035130-1a60-4ba3-a9be-b1a739c946db. NSAIDs can also worsen blood pressure control or fluid retention in some people. The older-adult issue is not only the drug name; it is frequency, duration, medical history, and whether the person is also using blood thinners, blood pressure medicines, kidney-affecting medicines, or more than one NSAID product by accident.

2. Oral decongestants for colds and sinus symptoms

Cold and flu aisles can be confusing because one box may contain several active ingredients. Decongestants narrow blood vessels to reduce nasal swelling, but the same action can make blood pressure harder to control. Mayo Clinic advises people with high blood pressure to choose carefully and notes that decongestants such as pseudoephedrine, ephedrine, phenylephrine, naphazoline, and oxymetazoline can be a concern; it specifically says not to use a decongestant if blood pressure is severe or uncontrolled https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/expert-answers/high-blood-pressure/faq-20058281. For an older adult with hypertension, coronary disease, arrhythmia history, or multiple medicines, the safer move is to ask a pharmacist or clinician before choosing a multi-symptom product.

Older adult consulting a pharmacist while choosing cold medicine | lilicooks.com

3. Systemic menopausal hormone therapy

Hormone therapy may be appropriate for some menopause symptoms, but age and timing matter. MedlinePlus explains that hormone therapy has risks and, for some women, may increase the risk of blood clots, heart attack, and stroke; it also says risk depends on the type of hormone therapy, how long it is used, and personal medical history https://www.medlineplus.gov/hormonetherapyformenopause.html. The Beers Criteria add an older-adult lens, noting that for women who start systemic hormone therapy at age 60 and older, risks are generally greater than benefits and include heart disease, stroke, blood clots, and dementia concerns https://pmc.ncbi.nlm.nih.gov/articles/PMC12478568/. This is a review topic, especially if therapy began years ago and has not been reassessed.

4. Antipsychotics in older adults with dementia-related symptoms

Antipsychotics can have a role in specific psychiatric conditions, but they carry special warnings in older adults with dementia-related psychosis. DailyMed labeling for risperidone says elderly patients with dementia-related psychosis treated with antipsychotic drugs are at increased risk of death, and it separately reports cerebrovascular adverse events, including stroke and transient ischemic attack, in elderly patients with dementia-related psychosis treated with risperidone https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=5e1eba05-036a-440f-85e3-a24b7ff3eb55. The Beers Criteria similarly advise avoiding antipsychotics for behavioral problems of dementia or delirium unless documented non-drug approaches have failed or are not possible and the person may harm self or others https://pmc.ncbi.nlm.nih.gov/articles/PMC12478568/. Families should ask what the target symptom is, how benefit is being measured, and when the plan will be reassessed.

5. Triptan migraine medicines in people with cardiovascular risk

Triptans such as sumatriptan are used for migraine attacks, but they are not suitable for everyone. DailyMed labeling for sumatriptan lists several cardiovascular and cerebrovascular contraindications, including coronary artery disease or coronary artery vasospasm, history of stroke or transient ischemic attack, peripheral vascular disease, ischemic bowel disease, and uncontrolled hypertension https://www.dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=e90b0eea-c424-4f00-98da-6ed6e80de1f6. The label also calls for cardiac evaluation in triptan-naive patients with multiple cardiovascular risk factors. That point matters in later life because a person may develop new risk factors after a migraine medicine was first prescribed. A periodic medication review can catch changes that an old prescription label cannot.

Clinician reviewing a medication list with an older patient and family member | lilicooks.com

How to make a safer medication review

A productive review is concrete. Instead of asking, “Is this medicine dangerous?” ask, “Is this still the right medicine for me now?” Bring a written list of every product used, including occasional pain relievers and cold medicines. Note the reason each one was started, how often it is used, what benefit you notice, and any dizziness, swelling, chest discomfort, unusual bleeding, sudden weakness, confusion, or blood pressure changes. Ask whether kidney function, blood pressure, fall risk, memory changes, or prior heart and stroke history should change the plan. Also ask which medicine should be avoided when buying over-the-counter products. This is especially important when different clinicians prescribe different medicines and no one person has recently reviewed the whole list.

When symptoms need urgent help

Medication review is planned care, but certain symptoms should not wait for a routine appointment. Seek emergency help for chest pressure, trouble breathing, fainting, sudden weakness or numbness on one side, sudden trouble speaking, new severe headache, sudden vision loss, or sudden confusion. If a new symptom begins soon after a medicine change, take the medicine list or bottle information with you. Do not delay emergency care while trying to decide whether a medicine caused the symptom.

Wrap-Up

The safest message is not that older adults should fear medicine. It is that medicines need periodic review as bodies, diagnoses, and other prescriptions change. NSAIDs, decongestants, systemic hormone therapy, antipsychotics used in dementia-related situations, and triptans all have cardiovascular or stroke-related cautions that become more important with age and individual risk factors. A careful review with a qualified health professional can clarify what remains useful, what deserves monitoring, and what should be handled differently.

Frequently Asked Questions

→ Should an older adult stop one of these medicines immediately?: No. Do not stop or change a prescription on your own. Some medicines need a planned review, and sudden changes can create new risks. Bring the full medicine list to a doctor, pharmacist, or qualified health professional.
→ Are over-the-counter pain relievers safer because they do not require a prescription?: Not automatically. NSAID pain relievers can carry cardiovascular, kidney, blood pressure, and bleeding concerns, especially in older adults or people with heart disease, prior stroke, kidney problems, or several medicines.
→ Why are cold medicines a concern for people with high blood pressure?: Some decongestants narrow blood vessels. That may help nasal stuffiness, but it can also raise blood pressure or make blood pressure harder to control. A pharmacist can help identify products without those ingredients.
→ What should families ask about antipsychotics in dementia care?: Ask what symptom the medicine is meant to address, what non-drug steps have been tried, what benefit would count as success, what side effects should be watched for, and when the medicine will be reassessed.
→ How often should older adults review their medicines?: A review is useful at least yearly and sooner after a hospital visit, new diagnosis, fall, blood pressure change, memory change, new prescription, or repeated use of over-the-counter pain or cold medicines.

References

This content was developed and refined using reliable sources.