DEAR DR. ROACH: I am an 83-year-old man. Except for blood pressure medication, I’ve never had any heart-related health issues. Earlier this year, I experienced six or so episodes of a fast, irregular heartbeat. After seeing a cardiologist, I was diagnosed with atrial fibrillation. I was prescribed Eliquis and amiodarone.

After doing a little research, I am very reluctant to start these medications. The possible serious side effects “that can lead to death” have scared me off. My questions are: Am I being foolish about not taking these medications, and are there alternative treatments for my condition? — T.B.

ANSWER: I fully understand why you would be concerned about taking very powerful medicines like apixaban (Eliquis) and amiodarone. Even when used properly, these medicines do have risks. Bleeding is the major risk for Eliquis, while amiodarone can cause toxicity to the lungs, thyroid, liver and eye. It can also paradoxically cause rhythm disturbances.

The reason you should reconsider is that the alternative (doing nothing) is worse. Your risk of having a blood clot, transient ischemic attack, or stroke is approximately 5% per year. If you have ever seen a friend or family member after a serious stroke, I think you would want to do what you could to prevent one.

Many studies have shown that even though these medicines have risks, these risks are much lower than the risk of a stroke with untreated AFib. Large studies following people with AFib have shown there are far more bad events that have come from not treating it than from bad effects due to drugs.

There are alternatives to amiodarone, but Eliquis and similar medicines are probably the best we have to prevent a stroke. Amiodarone is used to stabilize the normal rhythm of the heart, but your cardiologist could take a different approach by using a different, safer medicine that just keeps the heart rate in a safe zone.

I’d highly recommend you go back to the cardiologist and say why you got scared off. They can help design a regimen to protect you from blood clots and strokes while minimizing the risks from side effects of the drugs.

DEAR DR. ROACH: I am a 68-year-old female in good health, and I am not on any prescription medicines. I lift heavy free weights three times a week and walk two miles every day. I was wondering what your thoughts were on creatine supplements for seniors. Everything I’ve read says that it helps slow the decline as we age. — J.Y.

ANSWER: Creatine is a commonly used supplement for building muscle. The body of evidence for older adults is becoming stronger that creatine helps slow down the loss of muscle and even helps build muscle (along with exercise). This increases strength and may help to reduce falls.

Resistance training is important in older men but especially in older women as the benefits include not only a reduced fall risk but improved bone strength, so fractures are less likely. I don’t recommend creatine universally, but for older adults who want to improve their muscle strength, the evidence is strong enough for me to recommend it.

There are relatively few side effects, but water retention, temporary weight gain, decreased joint mobility, muscle cramping, and nausea have been reported. One commonly used dose is 3 grams a day, but people with kidney disease may need less and should check with their doctor.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.(c) 2025 North America Syndicate Inc. All Rights Reserved