Make sure you’re on the right meds
Igrew up in a household where taking medicine was discouraged – if pushed, my dad would take half a paracetamol, despite my assuring him that he may as well eat some chalk for all the benefit he was going to get at that dose.
When I qualified as a doctor, I started to scoff at his aversion to drugs, especially when I was working in a hospital where most patients I saw on my rounds rattled when they walked as a result of the number of pills handed out.
However, over the years, experience has shown me that we were both probably right – medicines can save lives, and crucially improve quality of life, but at times they can cause more harm than good.
Currently, many of us take medications daily. Often there is no alternative to this – the treatment works, and there aren’t any non-pharmacological options that can give the same result. However, what concerns me more is the growing number of people, especially older people, who are taking many different medicines every day, something referred to as ‘‘polypharmacy’’.
Polypharmacy is defined as the regular (that is, daily) use of five or more medications. In New Zealand, 35 per cent of people aged over 65 fall into this category.
This can be entirely appropriate and beneficial – for example, most people who have had a heart attack will be on medications to reduce their blood pressure, lower their cholesterol and stop clotting, all of which help prolong life and reduce the likelihood of further heart problems.
However, polypharmacy does increase the risk of potentially serious and dangerous interactions between drugs, and may cause side-effects that are worse than the condition they were trying to treat in the first place.
So if this sounds like you, how do you make sure the medicines you are taking are appropriate and are doing the right thing for your body?
Firstly, make sure you know exactly what you are taking, at what dose, and how often. If you are on multiple different things, keep a list so you don’t get confused. I find it hard to remember to feed the dog twice a day, so can’t imagine what I would be like if I had to remember to take medication every two or three hours!
Alternatively, you could get a ‘‘pill box’’, where your pills go into different compartments depending on the time of day you need to take them – a friend calls this her ‘‘Nana box’’ but I suspect they are invaluable for many.
When listing your medicines, ask your doctor or pharmacist to tell you the ‘‘generic’’ name of the drug, as well as the brand name. This is important so there isn’t any confusion if a brand changes and suddenly the packaging looks different, or the dose per tablet has altered.
Make sure your doctor knows about everything you are taking. This might include medicines you have decided to buy over the counter, which could potentially interact with something you have been prescribed.
An example of this is St Johns Wort, a substance used to help deal with low mood and stress. If used alongside certain types of antidepressant it can lead to a serious problem called serotonin syndrome, but doctors can’t advise you of this if they don’t know you are taking it. The same goes for vitamin and mineral supplements – just because they look and sound ‘‘natural’’ doesn’t mean that they can’t cause problems or interactions.
Ensure you take all your medicines as
Make sure your doctor knows about everything you are taking, including medicines you have bought over the counter, which could interact with something you have been prescribed.
prescribed – this means the right dose, at the right time, every day. If you don’t, and you find yourself regularly skipping doses, it will be hard for your doctor to work out what is going on if you don’t feel well or aren’t seeing the response you’d hoped for.
Make sure you understand why you are taking these medicines – firstly, this involves asking your doctor what the different drugs are being prescribed for. If they are things you have been on for ages, get them to write down what their role is – for example to lower your blood pressure or reduce your risk of a fracture if you fall – and don’t be afraid to ask whether there are newer, or better alternatives.
Once you know what your medicines are supposed to do, you should discuss with your doctor what your goals are – this may be very different from what your doctor thinks, and that’s fine. Your goal for example may be to have great quality, pain-free life, and be able to play bowls once a week. Your doctor may want you to live to 100 and have normal blood sugar.
Once you have this conversation, your doctor may view your medication needs differently – and as you are the one having to take them, it’s important they meet your goals, not anyone else’s.
If possible, set aside time to have a ‘‘medicine review’’ with your doctor. I appreciate this may be difficult, and it may require booking a separate or longer appointment than usual, but it can be valuable. At this time, you can talk through your
goals around your medication, as well as discussing any negative effects or symptoms you may be having (sometimes unpleasant symptoms can be due to the medicine, not the disease).
If the side-effects outweigh the benefits, it’s definitely time to talk about a change.
If you are on multiple different drugs, check with your doctor whether there is any opportunity to reduce this number – they may happily suggest a trial of one or more medicines, and then you can review how you go after a few weeks before making a longer-term decision. If there is one drug that is likely causing unpleasant symptoms, your doctor may be able to suggest an alternative that can give you the same benefits, without the downsides.
It is important that before you stop, reduce or start any medication you talk about it with your health provider, who can then make sure the choices you are making are safe and well thought out.