If you’re like many people, there will be times when you wonder if you’re doing all you can when it comes to taking medicines safely. Do you know enough about the possible side effects of the medicines you’re taking? Are you sure about the dose? Did you get the correct medicine at the pharmacy? Are you storing your medicines properly? It makes good sense to be concerned. According to a 1999 report from the Institute of Medicine (IOM), approximately 7,000 individuals die each year in the United States because of errors related to their medicines. Countless others experience a medicine-related problem or develop a new medical condition due to drug treatment. Sometimes the problem is unforeseeable. Other times, however, the health professional prescribing or dispensing the drug makes a mistake. Or the person taking it makes a mistake or doesn’t take the drug as prescribed. Taking medication safely is critical, and this article will explore some ways to help you avoid future problems.
Taking medication safely: Be sure to ask questions at the doctor’s office & pharmacy
To make sure you’re getting the right drug and that you understand why you’re taking it and how you should take it, you need to ask questions at the doctor’s office and at the pharmacy.
What should you ask about taking medication safely when you’re at the doctor’s office?
You’ve probably experienced doctor visits where you walked out with a new prescription and realized you didn’t really understand what it was. Perhaps the physician or the assistant hurriedly handed you the prescription before going out the door, or maybe you didn’t want to take up the doctor’s valuable time, and so you didn’t ask about the drug.
Number one rule
It’s your responsibility to learn about your medicines. Don’t be shy about taking time to ask your doctor questions about a new prescription. If you don’t understand something, ask the doctor to go over it again. You might want to bring a paper and pencil to your appointments so you can write down the doctor’s answers — studies show that most of us forget within 10 minutes what the doctor actually said.
Here’s a list of useful questions about your medication to ask your doctor
• What is the name of the drug, and how is the name spelled?
• Why are you prescribing this drug for me? What benefit will I get from taking it?
• How long will it be before I see improvement? How will I know it is working?
• What dose are you prescribing for me — how much should I take, and how often?
• How should I take the drug? (At what time of day? With food or a liquid?)
• How long should I keep taking the drug?
• What should I do if I miss a dose or remember it late?
• What side effects should I watch for, and what should I do if they occur?
• Do I need tests along the way to see if the medicine is working or to make sure that I’m not developing serious side effects?
• Will this drug interact with anything I’m already taking? (It helps to bring to your doctor appointments a list of all the prescription and over-the-counter drugs and supplements that you take, and their dosages, so the doctor can look the list over to check for interactions before writing a prescription. Also, remind the doctor of any allergies you have, or any adverse reactions to medicines you’ve had.)
Ask if the doctor has printed instructions you can take home with you. Finally, look at the prescription before you leave the doctor’s office — if you can’t read it, chances are your pharmacist can’t either.
What should you ask about taking medication safely when you’re at the pharmacy?
Pharmacies follow strict safety measures to decipher the prescription and deliver you the right medicine at the right dose. Still, some pharmacists are rushed, filling up to 500 prescriptions daily. They also must decipher the scrawled handwriting of numerous physicians, and some drugs have pretty similar names. Errors at the pharmacy are uncommon, but they do happen. Help yourself avoid them by checking the medicines you receive. In addition, prescription labels can be confusing. Surveys have shown that a common error occurs when patients misinterpret the dosage, for example, when they mistake a teaspoon for a tablespoon.
Here are some tips to keep in mind about filling prescriptions:
• Use the same pharmacy for all your prescription medicines. This allows the pharmacist to check for any potential interactions between drugs. Show the pharmacist your meds list, too, so he can check for interactions with over-the-counter drugs and supplements.
• Make sure it’s your name on the prescription the pharmacist hands you.
• Compare the label on the drug to the information you got at the doctor’s office. Are the name of the drug and the dose the same?
• If you’re picking up a refill, compare the pills to any remaining in the previous bottle. The new and old pills should be identical. One exception: If you take a generic version of the drug, your health plan or pharmacy may change to a different version along the way. As numerous manufacturers make generic medicines, the same medicine can come in various shapes and colors. But don’t assume that you’re just getting a different generic version of the same drug — always ask because a different pill can mean the prescriber or pharmacy has made a mistake.
• Have the pharmacist read the instructions to you. If you are still unsure, ask the pharmacist to go over the information again.
• Read any stickers added to the prescription bottles. Stickers are often where warnings are listed, such as to stay out of the sun or not to drive while taking the medicine. The stickers may also warn you if it is unsafe to crush your pills. Despite the stickers’ important messages, only 1 out of every 10 people read them.
• Consider filling your prescription earlier in the day. Most pharmacy errors occur between 4 PM and 6 PM, when scores of prescriptions are stacked up to be filled.
And don’t forget that you can always call your pharmacist (or doctor) later if you still have questions.
Set reminders to take your medication
“Did I already take my medicine this morning?” It’s sometimes hard to remember, especially if you take a number of different medicines with different doses. If you frequently ask yourself this question, you may find a pillbox useful. Keeping tablets and the like in a pillbox can reduce the chance that you’ll skip a dose or take a double dose. Many people use pillboxes that have seven individual compartments — one for each day of the week — and that can be organized for four doses (morning, noon, evening, and bedtime). Once a week, they organize a week’s supply of their medicines in the pillboxes so that they’ll always know whether they took their dose of a particular medicine or not. Some pillboxes even have alarms that alert you when it is time to take your medicine. If you use a pillbox, remember to hold on to the original container your medicine came in and the instructions that came with it in case you need to check something later on.
There are other aids designed to help you remember whether you’ve taken your medicine or not. Ask your pharmacist for a recommendation.
And on the subject of remembering — remember to take your medicine exactly as your doctor prescribed it. Don’t skip doses, and don’t increase your doses in the hope that a medicine that’s helping will help even more if you take more of it.
Store your medication properly
Medicines should be stored in a cool, dry place, which means that the bathroom, where many of us keep our medicines, is one of the worst places to do so. Bathrooms are warm and humid, and warmth and humidity can speed up the breakdown of a drug and cause it to lose potency. This is particularly the case with capsules and tablets. If you store your drugs in the kitchen, store them away from any heat-releasing appliances, such as the stove or sink. Some medicines need to be kept in the refrigerator, including the biologics that you inject yourself.
Here are some additional tips for storing your medicines:
• Take the cotton plug out of a drug container, because the plug will draw moisture into the container.
• Check the expiration date, and don’t use the drug past that date.
• Regardless of expiration date, don’t use medicine that has changed its color or consistency or that smells different.
• When you travel, put your medicine in your carry-on luggage so it won’t be exposed to extreme temperatures in the baggage hold. If you use a biologic or any other medicine that needs to be refrigerated, carry it in a cooler or a small insulated bag with an ice pack.
• Never leave medicine in a car, where heat can quickly damage its potency.
Reducing side effects & avoiding interactions
All drugs have potential benefits — and risks. Your doctor prescribes particular medicines for you in the hope that the benefits will outweigh the risks. Your discussions with your doctor and pharmacist should make you aware of a drug’s most common side effects and what, if anything, you can do to decrease your risk of getting them. If you do experience a side effect, a follow-up discussion with the doctor will help you decide if the side effect is worth the benefits you are receiving.
Also, as noted earlier, some medicines have the potential to interact with other medicines — prescription medicines, over-the-counter medicines, and supplements — and, occasionally, with certain foods. These interactions can increase or decrease a drug’s intended effects, cause you to experience side effects you wouldn’t experience if you were taking only one of the drugs, or make side effects worse. It’s difficult to keep track of all of this, which is why it’s so important that your physician, and your pharmacist, review all your medicines to keep the risks as low as possible.
Potential side effects and interactions of drugs commonly taken for arthritis
Don’t assume that you don’t need to pay attention if a drug you are taking, or a side effect or interaction, isn’t listed. The list is meant only to give you an idea of the range of side effects and interactions that are possible and the importance of being alert. Always ask your doctor and pharmacist about side effects and interactions, using your meds list as a prompt. (And remember that your doctor won’t necessarily rule out a drug because of its potential side effects.
Side effects of NSAIDS
Most people with arthritis take nonsteroidal anti-inflammatory drugs (NSAIDs) at one time or another. NSAIDs include aspirin and aspirin-like drugs. More often used in arthritis are traditional NSAIDs — for example, ibuprofen (brand names Advil, Motrin), naproxen (Aleve, Naprosyn), and diclofenac (Voltaren) — and the COX-2 inhibitor celecoxib (Celebrex). Arthritis specialists agree that NSAIDs are among the most effective treatments for the pain and inflammation of arthritis. But they can cause many side effects, ranging from heartburn, nausea, and stomach upset to gastrointestinal (GI) ulcers and bleeding, heart attacks and strokes, and kidney problems. As for interactions, there are more than a few. For example, taking an NSAID along with diuretics (water pills) prescribed to control your blood pressure may make the diuretics less effective. Taking an NSAID and a blood thinner such as warfarin (Coumadin) increases the risk of bleeding. And taking an NSAID and a corticosteroid such as prednisone increases the risk of stomach ulcers.
Side effects of DMARDs
Disease-modifying antirheumatic drugs (DMARDs) are often prescribed to treat inflammatory types of arthritis, such as rheumatoid arthritis (RA), lupus, and scleroderma. Methotrexate (Rheumatrex, Trexall) is the most commonly used DMARD; among others are hydroxychloroquine (Plaquenil), sulfasalazine (Azulfidine), leflunomide (Arava), azathioprine (Imuran), minocycline (Minocin), and gold injections.
With some of the DMARDs, the most serious potential side effect is infection. Individual DMARDs also have additional potential side effects. For example, hydroxychloroquine can cause eye problems (although this is rare), and methotrexate and leflunomide can irritate the liver. If you take a DMARD, your doctor will run tests from time to time to check for side effects.
Examples of interactions are that taking azathioprine and the gout medicine allopurinol increases the risk of liver problems, and that taking sulfasalazine with blood-thinning medicines increases the risk of bleeding.
Side effects of biologic response modifiers
Biologic response modifiers include etanercept (Enbrel), infliximab (Remicade), adalimumab (Humira), anakinra (Kineret), abatacept (Orencia), and rituximab (Rituxan). The biologics target specific parts of the immune system known to be involved in the inflammation of inflammatory types of arthritis. Side effects include a risk of serious infection and a rash at the injection site.
Side effects of analgesics
Analgesics are designed for pain relief, with acetaminophen (Tylenol) being the most widely used. Some doctors prescribe stronger analgesics, such as codeine, for severe pain. These stronger analgesics, or narcotics, may be combined with acetaminophen. Examples are acetaminophen with codeine (Tylenol No. 2) and hydrocodone with acetaminophen (Vicodin). Acetaminophen can have serious effects on the liver if you take higher doses than recommended or if you drink alcohol while you’re on the drug. Acetaminophen overdose is easier than you might think because acetaminophen is an ingredient in many over-the-counter cold medicines. People may take more than one drug containing acetaminophen without realizing it. (That’s why checking labels is important.) Narcotic analgesics may cause physical and psychological dependence over time.
An example of an interaction is that taking analgesics and tricyclic antidepressants, such as amitriptyline or doxepin, increases the risk of side effects from both types of drugs, including drowsiness and weakness.
Side Effects of corticosteroids
Many people with inflammatory types of arthritis take corticosteroids such as prednisone, which are among the most effective and fast-working drugs. Because they can cause some very serious side effects, including bone loss, cataracts, and high levels of blood glucose, the lowest possible dose for as short a time as possible is advised, although doses may be increased if arthritis flares are particularly severe.
Examples of interactions are that if you take corticosteroids and insulin or oral diabetes medicines, you may decrease the effectiveness of the diabetes drugs.
Side effects of supplements and certain foods
While most adults consult their doctors about prescription drugs, less than half tell their physicians about their supplement use. This is unfortunate since attitudes about alternative medicine have shifted over the last decade. Today your physician is likely more open to discussing supplement use. It’s also important because supplements sometimes have a positive and sometimes a negative effect on your other medicines.
For example, glucosamine and chondroitin sulfate can cause stomach upset, bloating, and other GI side effects in some people, and it’s possible that glucosamine can increase blood glucose levels, although the research on this is mixed. Ginger and devil’s claw may increase the risk of bleeding if you’re taking NSAIDs or corticosteroids.
If you do use supplements, which are not regulated the way drugs are, buy supplements with a United States Pharmacopeia (USP) seal or an endorsement from ConsumerLab on the label. These seals/endorsements don’t speak to the health claims of the supplements, but they do ensure that you are getting a quality product.
Occasionally, regular foods may enhance or interfere with certain medicines. One well-known example of this is grapefruit or grapefruit juice, which can affect how much of certain drugs gets into your bloodstream. These drugs include cyclosporine, certain lipid-lowering and heart medicines, certain blood pressure medicines, and some anti-anxiety drugs.
Safety first: Look after your medications properly
Taking a drug safely may require a little extra effort, but the added security is well worth it. The lessons of drug safety can be boiled down to a few simple rules: know what you are taking and why; follow directions; look after your drugs properly; and be alert to any possible side effects or interactions.
Want to learn more about medicines for pain conditions? Read “Prescribing Medicine: The Doctor’s Point of View,” “Over-the-Counter & Natural Pain Relievers for Joint Pain,” and “Pain Killers: Avoiding Addiction.”