I’m pleased to welcome my colleague, Dr. Jeff Foster, professor at the University of Colorado, who joins me as co-editor for this and future Medical Forums.
In April’s Healthcare Forum we’ll discuss some of the reasons prescribed medications are not effective or taken properly, and what we can do to assure their effectiveness.
But first, I’d like to thank my longtime friend and colleague, Dr. Bob Polombo, for his erudite suggestions in response to a recent medical forum. As most of us know, the Affordable Care Act (ACA) mandated that almost all Americans purchase health insurance or pay a tax penalty. The mandate ends in 2019. The success of the ACA partly depended on young, healthy Americans purchasing insurance to offset higher medical expenses of older Americans in order to keep down the cost of insurance premiums. Those, mostly the young and healthy, who now pay the penalty (currently 4 million) will escalate in 2019 causing insurance premiums for older Americans (including parents of those dropping insurance) to increase substantially. Many who drop their insurance can afford the premium and those who cannot may be eligible for a government subsidy to help pay for insurance. Young, healthy Americans who object to subsidizing their elders should remember that it was their parents, teachers and other mentors who helped them emotionally and financially during their upbringing. Consider encouraging your adult children, other young family members and friends to purchase insurance, not only for their own protection, but also for the financial well-being of their elders.
Returning now to this month’s topic. We were surprised to learn that one-third of medications prescribed by doctors never get filled at the pharmacy; that medication is often stopped prematurely and sometimes “forgotten” to be taken. We asked ourselves – why does this happen?
We came up with the following explanations:
- Taking medications is a daily reminder that something has gone wrong with our health – not always a pleasant idea to accept.
- The long list of potential side effects our pharmacist is required to give us when a prescription is filled is also disconcerting. Checking the Internet for information about side effects further increases our apprehensiveness.
- When the symptoms for which the medication is prescribed diminish or cease, we’re naturally relieved and may be inclined to stop the medication prematurely. A common example: stopping an antibiotic prematurely when the burning sensation that accompanies a urinary bladder infection ceases. Stopping the medication prematurely can cause the infection to return.
Considering these natural tendencies, what can we do to give medications the best chance of being effective?
When Your Doctor Prescribes a New Medication
Consider asking some of the following questions. Given the brevity of office visits, it’s helpful to prioritize your questions.
- What illness is this medication being used to treat?
- Does the medication replace any medication I’m currently taking?
- What are common side effects; how common are they; and what should I do if they occur?
- Is it safe to take this medication along with the herbal remedies, supplements, vitamins and the other over-the-counter pills I’m taking? Don’t be surprised if your doctor replies: “I didn’t know you were taking those!”
Interesting Illustrative Patient
Sylvia, a forty-year old housewife with two children, was being treated for severe depression for several years with prozac, an antidepressant that increases brain serotonin) and lithium carbonate (also increases serotonin). Unbeknownst to her doctor, she went to her neighborhood health food store complaining of insomnia and low energy. Without being asked by the store manager what prescribed medications she was taking, Sylvia purchased several expensive supplements, each containing 5-hydroxytryptophan and L-tyrosine—both amino acid precursors of serotonin.
Several weeks after starting the supplements, she complained to her doctor about confusion, irritability and tremors. When questioned, she finally revealed her excessive use of these supplements. She was diagnosed with a serious and potentially lethal “serotonin syndrome,” the result of increased levels of brain serotonin.
Supplements were stopped and prozac was temporarily discontinued. She was closely monitored by her family at home which circumvented a hospitalization. Within a week, her symptoms abated. Following this experience, her doctor began asking all his patients about their use of supplements, herbal remedies, etc.
- Is this new medication safe to take with alcohol and recreational drugs, such as marijuana? Be forthright about this to avoid the risk of increased side effects when combining medications with sedating substances.
- Are there activities I should avoid? For example, certain tranquilizers can make your skin sensitive to sunlight. Methotrexate, and other immuno- suppressant drugs sometimes used for severe arthritis and psoriasis, can aggravate pre-existing liver disease and cause lung disease, especially if alcohol is consumed.
When You Have the Prescription Filled at Your Pharmacist
- Check to see that the name of the medication, dosage, number of pills (or quantity of liquid medication) is correct. This is especially relevant if the medication is a controlled substance, such as an opioid for pain or a benzodiazepine for anxiety. You may want to step aside from the counter and make certain the number of pills is correct.
- Keep your medication in the original bottles rather than combining them in a single bottle because many look alike. Some find a pill dispenser useful as a reminder to take pills at the right time and whether or not a dose has been missed.
Additional Strategies to Use Medications Properly
We all know the following, but it’s nevertheless worthwhile to take a quick review.
- When traveling, keep medications on your person in case your luggage is lost.
- Although most medications are still effective for weeks past the expiration date noted on the bottle, throw out outdated medication to safeguard yourself and others from using them.
- If you’re seeing several health professionals, keep an updated list of the names, dosages of each medication, drug and other allergies in your wallet or as part of your personal health record (phr) that’s stored in your iPhone or other electronic device. When you visit your doctor(s), update him or her about changes because physicians don’t always communicate about you with your other health professionals. Having this information on your person can be lifesaving should you unfortunately find yourself in an emergency department where no one knows you.
We welcome your questions about today’s forum. Please leave any questions or comments below. We cannot answer questions about your personal medical problems because of medical-legal restrictions and because they are best addressed by your doctor.
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For May’s Forum, we’ll discuss the “Current Status of the Affordable Care Act” and how it may affect you and your family.
The new title of our book to be published in 2019 is “Doctors’ Inside Guide to Quality Affordable Healthcare.” Watch here for updates about the book.
good forum.please add me to your mailing list.
Hi, I love your blog, it’s so informative. With respect to April’s blog, is it important to take medicines at the same time every day? Also, how does one know if they should take their medications on an empty stomach or with food? And what if you are advised to take some medications on an empty stomach and some with food? Also, I’ve heard that you should never take your medications with orange juice … is that a myth?