Prescription for Health: “Take Exactly as Directed”
Look inside your medicine cabinet at your prescription bottles and ask: Have I read the label, stickered warnings and instructions? Have I discarded medications past their expiration dates? The Centers for Disease Control (CDC) reports that 80 percent of patients do not take their medications as prescribed. The prevalence of non-adherence to prescription directions has been cited as “America’s other drug problem” by the CDC. The agency estimates more than 125,000 people die annually from problems related to prescription medications, in part due to failure to read or follow label instructions. This number has the potential to increase dramatically over the next few decades, with the growing numbers of seniors, who are prescribed medication most frequently. Currently, 76 percent of Americans 60 and older use two or more prescription drugs, and by age 65, 42 percent take at least five medications weekly.
At every age, it is crucial to know the details about any medication prescribed to you. Consider these commonly asked questions, and you will understand why reading the fine print is essential.
Why do I need to finish an antibiotic? Probably the most common instance of non-compliance is taking fewer or partial doses of an antibiotic, which may allow the resistant bacteria to not only survive, but thrive. Taking a full course of antibiotics is the only way to kill all the harmful bacteria. Additionally, if the first course does not work, subsequent treatments may be more costly, with possible serious side effects.
What happens if I take more or less than prescribed? If you miss a dose, or take less because you feel better, the effectiveness may be reduced and can result in flare-ups of the condition—only if the prescription indicates ‘as needed’’ should you modify the dose. In most cases, experts advise returning to your regular medication schedule, but not to take two doses to make up for the dose you missed, as that can cause unintended side effects. Be careful not to take an extra over-the-counter pain relief pill (acetaminophen) for an intractable headache, as the narrow safety margin places many people “close to a toxic dose in the ordinary course of use,” according to the FDA.
Why do some medications need to be taken with food and others on an empty stomach? Stomach upset, a common side effect, can be lessened by taking a drug with meals, as indicated. For some medicines, the opposite is true, and ingesting food beforehand can delay or decrease absorption of the drug. If ‘take on an empty stomach’ is directed, take the medication first thing in the morning and wait 30 minutes before eating to give the body time to absorb it.
Why is the time of day important? Certain drugs are more effective or better tolerated with specific timing, according to new AARP research. Taking statins at bedtime is advised as cholesterol production in the liver is highest after midnight and lowest in the morning and early afternoon. Pain medications used for osteoarthritis are best swallowed four to six hours before the pain is anticipated to be at its worst. Asthma patients gain the most relief by taking oral medication in the mid-afternoon and inhaled steroids in late afternoon to prevent attacks most commonly experienced at night.
Why can’t I have alcohol with prescription medication? Consumption of alcohol when taking a prescription medication may cause nausea, headaches or fainting. It can also exacerbate medication’s effects, causing you to feel sleepy or lightheaded, and making it harder to concentrate and perform certain tasks.
Why can’t I drive or operate heavy machinery? Some drugs, like those for anti-anxiety, can dull alertness and slow reaction time, while stimulants can impair judgment. Common side effects of medication—drowsiness, dizziness, blurred vision, excitability—all point to the need to stay off the road.
Why should certain foods be avoided? Some medications may not work as well when taken with specific foods. For example, grapefruit contains a compound that affects the way a number of medications are metabolized by the liver and should be avoided or limited as indicated. When taking the frequently prescribed blood thinner warfarin (Coumadin), doctors recommend keeping your diet consistent, particularly with regard to your intake of leafy green vegetables which may impact blood levels.
Can I take drugs after the expiration date? Discard outdated drugs, which may not have full potency, particularly ones in solution or that require refrigeration. Take particular note of medications such as insulin, oral nitroglycerin, biologicals, blood products and epinephrine. Medications with preservatives, such as eye drops, may be unsafe past expiration, as bacterial growth can occur.
New technology can help, such as electronic pillboxes and smartphone apps, or simply use the tried and true pillbox.