Ask older patients to bring all their medications with them to the office visit. You and the patient should regularly review both prescription and over-the-counter medications, as well as herbal supplements. Special attention should be paid to medications with anticholinergic or sedating properties that may alter consciousness or physical function and impair or affect driving safety. These medications include opioids, benzodiazepines, and antihistamines. You can counsel patients about the risks and adverse effects of specific medications, their interactions, and the physiologic changes associated with aging. When relevant, you should also discuss with patients the legal implications of driving under the influence of a controlled substance.
You can use the following checklist to work closely with patients who are taking PDIs, particularly when a new PDI medication is prescribed or the dosage has been increased:
- Explain to the older adult and caregiver the effects of any new medication so that they will self-monitor for any adverse events that may affect driving.
- Ask the older adult and caregiver to take the first doses in a safe, non-driving environment to see if there are adverse effects, especially drowsiness, lightheadedness, or other conditions that may impair driving.
- Inform the older adult and caregiver about adverse effects that may diminish insight, or the ability to gauge a danger, without the older adult recognizing it.
- Educate patients about the risks of alcohol and other substances while driving and the effects of using them with certain medications.
- Emphasize adherence to critical medications even if there may be effects on driving. Medication is essential for the patient’s health. You may counsel cessation from driving until safety is assured.[1],[2] You can also refer patients to driver safety courses that review rules of the road and the impact of medications and medical conditions on driver safety. Higher-risk patients, such as those on antipsychotics or prescriptions for Parkinson’s, can also be referred to a driver rehabilitation specialist (DRS).
The U.S Food and Drug Administration (FDA) advises patients and doctors to talk about the effect medications can have on driving safety before patients start taking any new medication. The FDA provides a list of medications that should not be taken if operating heavy machinery (including motor vehicles).[3] You and your patients can review Some Medicines and Driving Don’t Mix to see how prescription drugs and over-the-counter medication affect patients’ driving ability.
You can also provide your patients with a fact sheet from the CDC, Medicine Risk Fact Sheet. The fact sheet provides basic information about the relationship between medications and driving. Patients and caregivers also can download other fact sheets that facilitate a personal action plan to guide a conversation with a doctor or pharmacist. These conversations should be prompted at least once each year or when patients change medications.[4]
[1] https://www.medscape.org/viewarticle/876904_2
[2] Pomidor, A. (2019). Clinician’s guide to assessing and counseling older drivers (4th edition, pp.148-149). The American Geriatrics Society. https://geriatricscareonline.org/ProductAbstract/clinicians-guide-to-assessing-and-counseling-older-drivers-4th-edition/B047
[3] U.S. Food and Drug Administration. (2021). Some medicines and driving don’t mix. Retrieved March 27, 2023 from https://www.fda.gov/consumers/consumer-updates/some-medicines-and-driving-dont-mix
[4] Centers for Disease Control. (2020). Are your medicines increasing your risk of a fall or a car crash? Retrieved March 27, 2023 from https://www.cdc.gov/transportationsafety/older_adult_drivers/meds_fs/