Managing your medications
By Kathleen Harte Simone
When taken properly, medications can effectively treat a condition or help cure an illness. But problems can arise when medications are not administered or prescribed properly. And, the more medications you take, the more likely you are to have a side effect or drug interaction.
Older adults are more likely than their younger counterparts to take multiple prescription medications, known as polypharmacy. According to data from the Kaiser Family Foundation, more than half (54%) of adults 65 and older and more than one-third (32%) of adults 50-64 take four or more prescription drugs each month. “Those taking six drugs have a 50% chance of a harmful effect,” said Patrick J. McDonnell, who holds a doctorate in pharmacy and teaches clinical pharmacy at Temple University.
The key to managing your medications effectively, according to health care experts, is to clearly communicate with a pharmacist and follow the recommendations accordingly. “Engage with your pharmacist,” McDonnell said. “Of all your health care providers, it’s really the pharmacist who is educated and trained in medication management. Pharmacists are on the same team with your doctors making sure that you receive optimal care.”
What to tell your pharmacist
For starters, tell your pharmacist what other medications you are taking, including prescription and over-the-counter drugs, dietary supplements, and herbal medicines. In a recent study conducted by WebMD, 53% of respondents get their prescription medications from more than one health care provider. This increases the risk of adverse drug effects. So, whether your prescriptions were written by one doctor or several, your pharmacist should be in the loop to assess them all for potential adverse drug interactions.
An example of two prescription medications that are contraindicated are amiodarone (taken for atrial fibrillation) and the blood thinner coumadin (also known as warfarin), because the first drug can block metabolism of the second. “However, it doesn’t mean they can’t be used together,” McDonnell said. “The risks of the two drugs together does not override the benefits of them (with) increased monitoring and more blood tests.”
Inform your pharmacist of all allergies. You may be surprised that some medications, particularly herbal supplements, are derived from common allergens. Making your pharmacist aware of any herbal remedies you take is essential also because some interact with prescription drugs.
Be sure to inform your pharmacist of your health conditions – both short-term and long-term – such as heart disease, diabetes and even a cold.
Side effect or medical problem
The easiest way to tell if a new symptom is a drug side effect or a medical problem is to ask yourself: “Did the symptom(s) start with the initiation of the drug? Did they get better when the drug was taken away?” If so, then, McDonnell says that it’s likely a side effect of the new medication. He also noted that medication side effects can appear at any time, especially if the dosage has been changed.
“A good example is if you’re taking the drug Lipitor and three weeks into therapy – during which you haven’t increased your physical activity – you can’t explain achiness, then it’s probably (from) the medicine,” McDonnell said. “But don’t just guess; consult with your doctor and pharmacist.”
Over-the-counter medicines
Surprisingly, common medications that bring people into the hospital because of adverse drug reactions include Motrin, Advil and Aleve, which are nonsteroidal anti-inflammatory drugs, or NSAIDs, McDonnell said. When taken with certain prescription meds, these pills can cause a potentially serious bleeding issue called gastric ulceration (commonly known as a stomach ulcer).
Common drugs for heart failure and blood pressure, angiotensin receptor blockers (ARBs) and angiotensin-converting enzyme (ACE) inhibitors, can also interact with NSAIDs and affect kidney hydration. Someone who is taking the ACE inhibitor lisinopril and is not feeling well or not eating may decide to take Motrin. This combination can block the kidney from functioning optimally or even cause acute kidney failure, McDonnell said.
“This is a case where Motrin is the straw that broke the camel’s back,” he said. “Sometimes the anti-inflammatory drugs can cause more harm than good. It’s really the fine balance of drug therapy – risk versus comfort.”
Vitamins and supplements
Dietary supplements and herbal medicines can be very beneficial for reducing symptoms or treating conditions, but they can also be problematic when taken with certain prescription medications.
“For example, many older people take glucosamine and chondroitin to help with osteoporosis pain,” McDonnell said. “Glucosamine is actually derived from shellfish. Patients with severe allergy to shellfish, such as shrimp, may unknowingly be predisposed to an allergic reaction. St. John’s Wort, another common supplement, which can be contraindicated with certain drugs, including those used after an organ transplant.”
Some prescription medications can cause cross-reactive allergies to the dyes in supplements and herbal remedies, so patients should be careful, read the label and consult with a pharmacist if they notice an adverse reaction.
Medication management can be very overwhelming, but knowledge is key. “Polypharmacy is clearly a reason to communicate with the pharmacist,” McDonnell said. “And, in some cases, to have a family member serve as an advocate, especially if (the patient’s) cognitive function is compromised.”
Questions to ask your pharmacist when prescribed a new medication
- What specifically is this medication used for?
- How should I take this medication? Understand when, how often, under what conditions, and how long to take the medication.
- Where should I store the medication? Some medications require refrigeration. Others should be stored at room temperature.
- Is this safe to take with my other medications and supplements? Consider all other prescriptions, herbal supplements and over-the-counter medications that you’re taking.
- Should I avoid certain foods and/or alcohol while taking the medication?
- What side effects might I encounter? Know what to expect and what to do if you encounter side effects that may require medical attention. Mention any allergies that could be worsened by the drug.
- What should I do if I miss a dose? Get guidance on how to get back to proper dosing, which may vary depending on the drug. Seek assistance if forgetting to take medication becomes routine.
Kathleen Harte Simone is a Philadelphia-based journalist.
