When medications stop working — recognizing the need for a change

This article is for educational purposes only and does not constitute medical, legal, or financial advice. Every family situation is different, and you should consult with appropriate professionals about your specific circumstances.

Your parent has taken the same blood pressure medication for seven years. It worked well. Their blood pressure was controlled. Then their last three visits show blood pressure climbing back up. The same medication that kept them stable now seems useless. Or your parent took a medication for arthritis pain that used to help. Now they complain that it doesn't touch the pain anymore. They're suffering again. Something that worked has stopped working.

Medications stop working for many reasons. Your parent's body changes with age. Their kidney and liver function declines. The disease they're treating progresses. Tolerance develops where the medication gradually becomes less effective. They've gained or lost weight significantly, changing medication levels. They've started new medications that interact. Any of these can cause a previously effective medication to become ineffective.

When medications stop working, your parent needs different medications. But recognizing medication failure takes observation and honest conversation. It requires distinguishing between true medication failure and other explanations. It requires courage to tell the doctor that something isn't working and persistence to find something better.

How Medication Failure Looks

True medication failure is when the medication stopped doing what it was supposed to do. Your parent's blood pressure is high again despite taking blood pressure medication daily. Your parent's depression has returned even though an antidepressant used to help. Your parent's pain is uncontrolled despite their pain medication. The medication was working. Now it's not. The failure is the medication, not your parent's adherence.

This is different from medication side effects. Side effects might be intolerable, but the medication is still doing its job. Your parent's blood pressure is controlled, but the medication makes them dizzy and weak. The medication works, but the side effects are unacceptable.

Medication failure is also different from a progressing disease. Your parent's arthritis pain worsens over time because arthritis progresses. That's disease progression, not medication failure. The medication is doing what it's supposed to do, but the disease is getting worse than the medication can control.

Understanding the difference matters because the solution differs. If medication side effects are the problem, you might lower the dose, switch to a different medication, or add something to manage the side effects. If disease progression is the problem, you need a stronger medication or additional treatment. If the medication has truly stopped working, you need a different medication.

Keeping Track of What Matters

You're your parent's best observer. You see them regularly. You notice when something changes. Start tracking medication effectiveness. If your parent is taking medication for pain, how bad is their pain on a scale from one to ten? Is it improving, stable, or worsening? If your parent is taking medication for blood pressure, are you noticing symptoms of high blood pressure like headaches or nosebleeds?

For depression or anxiety medication, how is your parent's mood? Are they more engaged with life or withdrawn? Are they sleeping better or worse? Are they managing daily activities? Some changes are subtle. Your parent might be slightly more withdrawn or sleeping a bit more poorly without saying anything. You notice because you know them well.

Keep a simple record. You don't need to be formal. Just jot down observations. "Mom's pain seems about the same as last month. She's still struggling with stairs." Or "Dad's blood pressure has been elevated at his last two doctor visits. I've noticed more complaining about headaches." This information becomes valuable when you talk to the doctor.

The Conversation With Your Doctor

When you suspect medication failure, schedule an appointment specifically to address it. Don't wait for a routine visit and hope the doctor notices. Come prepared. Bring your observations. Be specific. "The migraine medication isn't working like it used to. Mom's getting migraines twice a week now instead of twice a month." Or "Dad's anxiety medication was great for the first two years, but over the past few months he's anxious again, especially at night."

Doctors appreciate specific information. It helps them determine whether the medication has truly failed or something else is happening. They might order testing to confirm. Blood work might show that a medication isn't at the right level in your parent's bloodstream. Imaging might show that a disease has progressed. Sometimes what seems like medication failure is actually something else entirely.

Ask your doctor directly: "Do you think this medication is still working?" Some doctors assume you're satisfied with current medications unless you say otherwise. Giving them permission to reconsider medications opens the conversation.

Making the Switch

Once you and the doctor agree that a medication isn't working, the next step is finding something better. Your doctor might suggest a different medication in the same class, a different dose, or an entirely different approach.

Some medications can be stopped immediately. Others require tapering because stopping them abruptly causes problems. Your doctor will specify which approach is appropriate. Never stop a medication without clear instruction from the doctor because some medications cause serious problems if stopped suddenly.

During the transition period, monitoring matters. Your parent is off the ineffective medication and starting something new. They need follow-up within a week or two to see how the new medication is working. Some medications take weeks to reach full effectiveness. Your doctor might say, "Give this medication three weeks before deciding whether it's working." Other medications work immediately. Your doctor will tell you what to expect.

Trying Multiple Medications

Finding the right medication sometimes requires trying several. Your parent might need medication number one, which doesn't work. Then medication number two, which causes terrible side effects. Then medication number three, which helps but not completely. This process is frustrating and exhausting. Your parent might feel discouraged. You might worry that nothing will ever work.

Stay persistent. Different people respond to different medications. What didn't work for your parent might work for someone else. What didn't work the first time might work if the dose is different. Often the answer isn't the first thing you try.

Be patient but not infinitely patient. If a medication clearly isn't working after a reasonable trial period, move on to the next one. Don't keep your parent suffering on a medication that isn't helping. But also don't switch every week expecting immediate results. Most medications need time to work.

Tolerance and Medication Failure

Sometimes your parent's body adapts to a medication, making it less effective over time. This is tolerance. Medicines that usually cause tolerance include pain medications, anti-anxiety medications, and sleep medications. Your parent takes the medication for months and it works great. Then gradually it works less. They need higher doses to get the same effect. This is tolerance, not disease progression.

Tolerance is real and requires a solution. Sometimes the solution is adding something to make the original medication work better. Sometimes the solution is switching to a different medication. Sometimes the solution is taking a break from the medication and restarting it later when tolerance has lessened.

Talk to your doctor about tolerance if you suspect that's what's happening. There are strategies to manage it, but they require medical guidance.

Disease Progression Versus Medication Failure

When a disease like arthritis or heart disease progresses, medications become less effective not because they've stopped working but because the disease has worsened. Your parent's arthritis is more severe than it was when the medication was started. The same medication that controlled mild arthritis might not control moderate arthritis.

This requires different solutions than medication failure. Your doctor might increase the dose. They might add another medication. They might suggest non-medication approaches like physical therapy or surgery. Understanding that it's disease progression, not medication failure, helps your doctor choose the right approach.

When to Persist and When to Accept

Sometimes your parent and doctor exhaust reasonable medication options. You've tried several medications and none work well enough or side effects are unacceptable. You've optimized doses. You've tried combinations. You're still not getting the results you want.

At that point, you have to make peace with what's possible. Sometimes medications have limits. Sometimes your parent's disease progresses despite our best efforts. Sometimes you have to shift from trying to cure or control a symptom to managing it as well as possible and focusing on quality of life.

This is a hard moment. You've done everything right and it's still not enough. Your parent might be disappointed or grieving. You might be too. Give yourselves permission to feel the sadness of this reality. Then talk to the doctor about what you can do. What non-medication approaches might help? What can you do to make your parent more comfortable? What goals matter most now?

Advocating When Your Doctor Seems Stuck

Some doctors get attached to medications. They've been prescribing the same medication for decades. They don't notice when it's not working anymore. They assume side effects are part of aging. They don't revisit medications unless you push.

If you suspect your parent's doctor isn't recognizing medication failure, request a medication review appointment specifically to address this. Ask for a referral to a geriatrician or clinical pharmacist. Get a second opinion if you need to. Your parent deserves medications that actually work.

Your Role as Observer and Advocate

You're the continuity in your parent's life. Doctors come and go. Medications change. But you're there regularly, observing how your parent is doing. You notice when medication stops working. You remember when something used to help and doesn't anymore. You care enough to speak up when something needs changing.

That role matters. Your observations and advocacy help your parent get appropriate medications. Your willingness to say "this isn't working" opens the door to finding something better. Your persistence helps your parent avoid staying on ineffective medications indefinitely.

How To Help Your Elders is an educational resource. We do not provide medical, legal, or financial advice. The information in this article is general in nature and may not apply to your specific situation. Changes to medications should always be discussed with and guided by your elder's healthcare provider.