Time to Take Your Medicine!

View PDF

Eight ways to be a better prescription user

Anne Bokma

Dr. Peter Zed will never forget the older female patient who was so anxious to be alert for her granddaughter’s graduation that she skipped her diuretic and blood pressure medication for several days before the ceremony. The drugs caused her to wake up and go to the bathroom at night, and she needed a few nights of undisturbed sleep.

“Unfortunately, her plan backfired, and she ended up in emergency with heart failure problems on graduation day. She didn’t understand the consequences of not taking her medication properly,” says Zed, a clinical coordinator and pharmacotherapeutic specialist at the Queen Elizabeth II Health Sciences Centre in Halifax.

Recently, Zed helped conduct a research study that revealed that 24% of all drug-related admissions and 12% of emergency-room visits at a major Canadian hospital were medication-related. Drug non-compliance was a common cause in both these findings.

The incorrect use of prescription drugs is a serious problem in Canada. Studies show that 50% of us don’t take our medications properly, and 33% either fail to fill our prescriptions at all or fill them but don’t take them. A case in point is Elizabeth Smyth, a 53-year-old Toronto-based market research executive, whose doctor prescribed her the selective estrogen receptor modulator raloxifene (Evista) because she was showing some bone loss (osteopenia) in her lower spine. “I was all gung-ho to take it but when I picked up the prescription, the pharmacist told me it drug might cause or worsen hot flashes,” Elizabeth recalls. “I was already having a hard time with night sweats and insomnia, having just gone off hormone replacement therapy, so I never took the raloxifene — though my intentions were good!”

Like Elizabeth, many patients don’t like the side effects; others have difficulty keeping track of multiple-drug regimens or just forget to take their pills. “Sometimes the problem is as simple as having difficulty swallowing a pill or not liking the taste of a medicine,” says Nathalie Plante, first director of pharmacy services for the Jean Coutu pharmacy chain in Longueuil, Que.

And a person with an asymptomatic condition such as hypertension does not feel sick and may forget the consequences of not taking antihypertensive drugs as prescribed. “If you’re taking a medication for high blood pressure and you have no symptoms from your condition but the medication makes you dizzy, you may think the cure is worse than the disease,” says Plante.

Canadian consumers are also cavalier about taking non-prescription remedies. Only 18% of consumers read the directions on non-prescription products, according to an Ontario Pharmacists’ Association (OPA) survey. Another OPA survey reveals that only 54% of people consult a doctor and just 17% consult a pharmacist before using prescription and non-prescription products simultaneously — despite potential dangers, notes Sherrie Hertz, director of pharmacy programs for the OPA. Many cough and cold products contain a decongestant, which can increase heart rate and blood pressure and interfere with medications taken for heart conditions, she says.

Photo: Boris Yankov/istockphoto

1. Understand the instructions

Write down the directions for taking the drug when the doctor writes you the prescription in her office, advises pharmacist Christine Stewart, president of the Toronto-based consulting firm Christine Stewart & Associates. Clarify those instructions with the pharmacist when you fill the prescription. Carefully read the labels on all non-prescription or herbal remedies and check with a health-care professional to see if they are safe to use with other medications. “Your role as a patient is to ask questions, clarify and be sure you understand the instructions,” says Stewart.

2. Don’t use expired medications

Non-prescription drugs have a best-before date, so check them once a year and look at expiry dates. Do not store leftover prescriptions “just in case.” If your prescription has been changed or discontinued, return any unused drug to the pharmacy for safe disposal.

3. Pay attention to the labels

Some prescription vials come with auxiliary labels or stickers with warnings: take with food, take on an empty stomach, avoid taking with alcohol or keep refrigerated. “Pay attention to those warnings. I you don’t, the medication might not be able to do what it’s supposed to do,” she says.

4. Simplify your dosing regimen

If you have trouble swallowing a pill, ask the pharmacist if there’s a chewable tablet, or if the drug could be made available in liquid form. Some people prefer to split a tablet to make it easier to swallow, but certain drugs do not work properly if altered in any way. Check with your pharmacist or doctor before splitting any of your pills.

As for  children, if it’s difficult to get a youngster to take three doses of an antibiotic a day, ask your doctor if it’s possible to get the drug in a once-a-day formulation.

5. Determine the right dosage for children

Many non-prescription children’s medications give dosing instructions according to weight. Check the label each time before giving a medication to a child. As the youngster grows and gains pounds, adjust the dosage according to her current weight.

6. Don’t stop your medication prematurely

If the instructions advise you to finish the entire course of treatment, you need to do so. Otherwise, you risk having a relapse. Don’t stop taking a drug even if you feel better.

7. Fill all your prescriptions at one pharmacy

Frequent a single drugstore and get to know your pharmacist just as you would any other health-care professional. This way, the pharmacist will have and be able to update a comprehensive record of your medications. That will help you take your drugs properly and reduce the chance that you’ll make drug errors. “Don’t ever think that pharmacists are too busy to answer your questions. That’s why they’re there,” says Stewart.

8. Use reminders

If you have trouble remembering your dosing schedules, a reminder system can help. Instead of coming in large vials of pills, medications can be organized into daily dosette packages, with individual doses popped out from a blister pack. This simplifies remembering what drugs to take and when. Some people post reminder notes on the fridge or near their telephone at work. Others keep their meds beside their toothbrush. There are also high-tech reminder tools such as auto messaging systems. These prompt your telephone to ring when it’s time to take another dose. Your pharmacist can tell you how to set up these systems.