Source: Harvard Women’s Health Watch
How many pills do you take each day? Five? Six? Many people are on a multitude of medications, prescribed to treat several different health conditions. Yet not every medicine we take may be safe, effective, or appropriate for us.
Part of the problem is that prescribing medicines isn’t as straightforward as we get older. For one thing, our bodies metabolize medications differently. For another, we take more medicines than we used to, and they have the potential to interact with one another.
“There are more known risks to medications as you get older, and fewer certain benefits,” says Dr. Anne Fabiny, chief of geriatrics at Harvard-affiliated Cambridge Health Alliance and editor in chief of Harvard Women’s Health Watch.
Doctors need to balance the various benefits and side effects for all the drugs we take, often without a complete understanding of each drug’s comparative effectiveness.
“For many medications, there’s an absence of data, particularly on how drugs compare with one another and which one is the most appropriate therapeutic option,” says Dr. Niteesh Choudhry, associate professor at Harvard Medical School and associate physician in the division of pharmacoepidemiology and pharmacoeconomics at Brigham and Women’s Hospital, Boston, Mass. The lack of evidence is especially striking in people over age 65, who are underrepresented in clinical drug trials.
Another issue is the doctor-patient time crunch. If your doctor is juggling a large number of patients, you may only get 15 minutes of face-to-face time during each visit. That doesn’t leave much time for your doctor to discuss whether a medicine is appropriate for you.
DANGERS OF MISUSED MEDICINES
Every drug is meant to treat a condition or symptom. Clopidogrel (Plavix) helps prevent clots that can lead to heart attacks or strokes. Simvastatin (Zocor) lowers cholesterol. Metformin (Glucophage) reduces blood sugar to treat diabetes. Yet every drug can have side effects, which range from mild to life-threatening.
“If we’re prescribing appropriately, we will give medicines for which the benefits outweigh the risks,” Dr. Choudhry says. “If we’re prescribing inappropriately, the risks will outweigh the benefits. In some cases, there are no benefits and all risks.”
Those risks aren’t just physical, but financial, too. Drugs cost money, even when you have health insurance. If you’re on a fixed income and trying to save money, you might end up cutting back on a drug you need to pay for one that’s unnecessary.
KNOW WHAT YOU’RE GETTING
Because time pressures may prevent your doctor from providing a very deep explanation of why he or she is prescribing the medicine, you need to take the initiative.
“When a physician suggests a new medication or a change in the dose of a medicine you’re taking, you really need to ask questions so that you clearly understand why the doctor is suggesting it, and what the medicine is going to do,” Dr. Fabiny says.
Also ask what adverse effects the drug might have, and which ones are serious enough to warrant a call to your doctor. Some drugs have predictable side effects–for example, hydrochlorothiazide for high blood pressure can make you go to the bathroom more often. Knowing that ahead of time will prevent you from becoming alarmed and stopping the medicine unnecessarily.
Also, find out how long you’ll be on the medicine and what to do when you run out. After you’ve been taking the medicine for a month or so, check back in with your doctor to let him or her know how you’re doing.
QUESTIONS TO ASK YOUR DOCTOR
1. Why are you prescribing this drug?
2. How is it supposed to treat my condition?
3. Has it been tested and found to be safe and effective for people my age?
4. What side effects might it have, and what should I do if I have any of them?
5. At what dose are you starting me, and why?
6. Will you eventually increase or lower the dose?
7. Is there a lower-cost generic alternative to this drug available?
8. Can you put me on a drug regimen that will be easier for me to take (for example, once a day instead of several times a day)?
9. For how long do you want me to take this medicine?
10. What should I do when the medicine runs out? Will I need to refill the prescription, and if so, how can I get the new prescription from you?
WHY SKIPPING ISN’T SAFE
Just as dangerous as taking a medicine that’s wrong for you is failing to take a drug you need. Earlier this year, Dr. Choudhry did a study evaluating how well patients took their statin medicines, which are used to treat high cholesterol. He and his colleagues found that women were 10 percent more likely to skip these medicines than men. Considering that high cholesterol is a significant risk factor for heart attack and stroke, failing to take a prescribed statin could have serious implications.
There are many possible reasons for not taking medicine as prescribed. Women may be more likely to have side effects from medicines than men, or to have lower incomes that prevent them from paying for their medicines.
Don’t let these, or any other reasons stand in the way of you taking the medicines you need. If money is an issue, see if there’s a generic version, or look into patient assistance programs (such as NeedyMeds:
).
If you’re having trouble remembering to take your medicines, a few techniques and devices can help:
1. “Keep your medications in a place where you’re going to see them every day,” Dr. Choudhry says. He recommends storing them next to your toothbrush, which you’re sure to use at least twice a day.
2. Get a pillbox. The simplest boxes will organize your pills by day, but higher-tech versions will let you set alarms to remind you when it’s time to take your medicine.
3. Set a reminder on your cell phone. Smartphone apps will remind you to take your medicines, and help you keep track of every drug you take.
4. Keep a list of your medicines. Record them on paper or in the notes section of your smartphone, so you’ll have the list with you whenever you visit your doctor or specialists.
FOLLOW UP
Whenever you start on a new drug, change the dose, or expericence a side effect, let your doctor know. Remember that side effects can appear months or even years after you start taking a drug. At every visit, review your entire list of medicines with your doctor. Discuss whether you need to:
1. Stop taking a drug for a condition you no longer have or add a medicine for a new condition
2. Substitute a drug that has fewer side effects than one you’re taking
3. Change the dosage of a medication
4. Identify medicines that could potentially interact with one another
5. Simplify your drug regimen by taking medicines at the same time of day or condensing doses
6. Lose weight or implement other lifestyle modifications to help you scale back or stop taking certain medicines.
Make sure your primary care physician knows about every medicine you’re taking–including pills prescribed by specialists and over-the-counter drugs and supplements you buy yourself. Your doctor can check to make sure the drugs don’t interact with one another and that you’re not wasting money on drugs you don’t need.
If you’re considering stopping one of your medicines because you don’t think it’s working or you’re worried about side effects, let your doctor know first so you don’t put your health at risk. You and your doctor can explore other options that are easier for you to take, such as lowering the dose or switching to a different formulation.
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