High blood pressure, high cholesterol and diabetes. Whether you have one of these conditions or all three, chances are your doctor has recommended dietary changes, urged you to increase your level of physical activity and prescribed a couple of medications that you need to take at certain times of day, spaced out so that you don't take one within two hours of the other–oh, and one must be taken on an empty stomach, the other with food.
Who can remember all this stuff? And one of the pills is hard to swallow. I give up!
Don't give in to the temptation to skip doses or stop taking medications because you feel overwhelmed. Not taking medication as prescribed can have serious, even life-threatening, consequences.
Going off high blood pressure medication abruptly can cause a condition known as “rebound hypertension,” a severe form of the condition that can lead to stroke.
Stopping a drug that helps normalize heart rhythm can lead to heart arrhythmia, which can cause a heart attack, stroke or even sudden cardiac death.
Not taking the blood-thinning drugs often prescribed after a heart attack may lead to a second–this time, preventable–heart attack.
According to the World Health Organization, about half of the prescriptions written in developed nations, including the United States, are not taken as directed. Here are some common reasons why–and what you can do about them.
☑ Keep a list of all of the medicines you take, including over-the-counter medicines, vitamins and herbs.
☑ Show your doctor and pharmacist your medicine list at each visit. Tell them about any allergies you have.
☑ Keep written information about your medicines in a safe place, and read it if you have questions.
☑ Take your medicine just like your doctor or pharmacist tells you to.
☑ Call your doctor right away if you are having problems with your medicine.
☑ Do not stop taking a medicine without first talking to your doctor.
☑ Do not take a medicine prescribed for someone else.
☑ Ask your doctor about using a weekly pillbox.
“I've been prescribed so many pills by so many doctors, I just can't keep track!”
▪ Make a list of all of your medications–over-the-counter nostrums and nutritional supplements, too. For each, note the condition it treats, the dosage and how often it is taken. If you are seeing several doctors, review this list with the one who is most familiar with all your medical conditions.
▪ Discuss which medications, if any, can be dropped. Keep in mind that many drugs cannot be discontinued suddenly so you may be slowly weaned off unnecessary prescriptions over a period of weeks to avoid serious side effects.
▪ Find out whether you can switch to a medication that is taken fewer times a day–or whether you can substitute a drug that treats more than one condition, such as high cholesterol and high blood pressure.
▪ If the doctor drops a medicine, changes a dose or adds a new prescription, be sure you understand why the change in treatment is being made and your treatment goals. Update your list of medications to reflect these changes.
▪ Be sure you understand instructions for taking a new medicine before you leave the doctor's office, hospital or pharmacy.
“I keep forgetting to take my medication.”
▪ Use a timer or your watch alarm that beeps when it is time to take medicine.
▪ If you have a handheld computer, program the calendar function to set up “appointments” throughout the day when it's time to take a prescription.
▪ Use a pill organizer with separate compartments for each day and time of day (morning, noon and evening)–or divvy up your medicines into two different colored pillboxes, one for day and one for night. Get into the habit of filling your pillbox(es) on the same day every week.
“I have this one pill that's so big, it gets stuck in my throat.”
▪ Ask your doctor or pharmacist whether your pill can be crushed up and mixed into pudding, applesauce or another soft food. You might not always have this option, because some pills must be taken whole to work properly and can even be dangerous when crushed. For instance, if you crush a “timed-release” pill you will get too much into your system too fast.
▪ Your doctor may also be able to substitute another medication, or may switch you to a liquid, patch, spray or inhaled formulation.
“I feel fine when I don't take my medication, and sick when I do.”
▪ Whenever you are given a new prescription, keep a diary noting when you started taking it, whether/when you experienced adverse effects, whether/when you stopped taking it, and how long you need to take the medicine before you reach treatment goals that you and your doctor have discussed.
▪ Tell your doctor right away if you are experiencing any side effects from your medication. The fastest way to get rid of a side effect is to talk to your doctor.
▪ Review your medication list with your doctor to determine whether there is a drug interaction that is causing the problem.
▪ With any luck, side effects will be temporary and resolve on their own after a month or two. If not, you can discuss substituting another medication.
▪ If you're embarrassed to discuss gastrointestinal or sexual side effects, don't be. Your doctor already knows these side effects are possible, and you will not be the first or only patient to experience them. And keep in mind that a sexual problem may not be caused by your medication, but may be a sign or symptom of another illness that is undiagnosed or poorly controlled, such as diabetes.
“My medicine did not work, so I stopped taking it.”
▪ Review the results of blood pressure, cholesterol or other tests the doctor has given you over a period of time to see whether you are progressing toward–or have reached–your treatment goals. You should also test your blood pressure and blood sugar at home.
▪ If you are taking your medication as directed and it really isn't doing the job, your doctor can prescribe something else or add another medication to your treatment regimen.
sources: american heart association; Bradley Leonard, M.D., chief of cardiology at the Baylor regional Medical center (Plano, texas); Michael Militello, Pharm.D., cardiology clinical pharmacist at the cleveland clinic (cleveland, Ohio); James J. rybacki, Pharm.D. president of the clearwater group (easton, MD) and author of The Essential Guide to Prescription Drugs (24th ed).
The Caregiver's Role In Compliance
If you suspect that a loved one isn't taking his or her medication as prescribed, you're going to have to find out why.
Check pill bottles. If a prescription was filled a month earlier and the bottle is still full, ask why. And if a bottle is empty and the label indicates that it should be refilled one or more times, ask whether it has been refilled.
If the pharmacy is inconvenient to get to–as when driving is no longer medically advisable–the doctor can call in a new prescription. And most pharmacies now use automated systems that allow you to refill prescriptions after hours by using your telephone's keypad. Some pharmacies will even deliver prescriptions.
If your loved one is unsure why a medication has been prescribed, has experienced side effects or is having difficulty following the dosing instructions, arrange a meeting so that the doctor can explain to both of you why and how the medication should be taken.
If necessary and feasible, take charge, and give the right dose at the right time to your loved one yourself.
HERE ARE SOME QUESTIONS YOU SHOULD BOTH ASK:
▪ What is the name of the medicine, and why am I taking it?
▪ What is the daily dosage I need, and how many times a day do I take this medicine to get this dosage?
▪ What side effects should I watch for?
▪ Which of these side effects should I report to you?
▪ Do I need to come in for lab tests related to taking this medicine?
▪ Are there things I should avoid while taking this medicine?
▪ How long should I stay on this medicine?
▪ How will I know if it is working?
© 2007 American Heart Association, Inc.