Keep taking the tabl ts!

If you’re one of the many British women who are on long-term medication, Dr Sarah Brewer offers some tips to ensure you take the right dose, at the right time

Many of us have repeat prescriptions for our health conditions – in fact, there are around 28 million people on long-term medication in the UK. Yet, astonishingly, people who are prescribed medicines typically take only half of their doses.

WHY IT HAPPENS

So why are so many people failing to take their medicine? The reasons are complex, but simply forgetting is, not surprisingly, the main one. If you’re taking eight or more tablets per day, at different times, it’s understandable that it’s difficult to keep track, especially if you have a symptomless condition, such as high blood pressure or raised cholesterol. Other explanations include misunderstanding the condition or its treatment, fear of side effects, denial, or confusion over a frequent or complex dosing regimen.

Even patients with persistent symptoms, such as pain or breathing difficulties, may choose not to take their medicines as prescribed, perhaps because they worry their medication will become less effective with regular use. They may also feel the medication isn’t immediately effective, or may see their treatment as hopeless. The problem is that medicines don’t work if they’re still in the packet – you have to take them to gain the benefits!

CHECK WITH YOUR GP

If you have concerns about taking your medicine, talk to your doctor or pharmacist, who can explain, for example, that your medicine will not become less effective with continued use, or that it may take a month or more for you to reap the benefits of your medication.

If you find the number of pills and capsules you have to take troublesome, or you have difficulty swallowing, tell your doctor, as other treatment options and formulations are often available, such as syrup or patches.

A pharmacist can also advise on which tablets can be safely crushed or split in half to make swallowing easier – some shouldn’t be broken down as it may affect their absorption. The pack’s patient information leaflet will also usually tell you if a tablet must be swallowed whole or can be safely chewed or crushed.

MEMORY TRICKS

As a medical student on the Pill, I had to rely on a poster over my bed to remind me to take my daily dose. Then came phones with programmable alarms, and now there are apps that can send you a text and flash messages to help you remember to take your medicines.

It’s easier to remember if you get into a routine and take them at the same time each day; for example, before or with a meal such as breakfast (check if your medicine should be taken with or without food).

You could set a reminder on your watch, mobile phone or computer. Medication organisers are also available, which have separate compartments into which you can put your daily doses for an entire week.

GET THE APP

Echo is a free app that allows you to scan the barcode of your medicine in order to request a repeat prescription.

Once the prescription is approved by your GP, it is posted to you free of charge. The app then reminds you to take your medicine, and tells you what dose you need. It also prompts you when you need to reorder a new repeat prescription, and when you need to see your GP for a follow-up assessment. Download Echo via the App Store or from Google Play.

HELP WITH MULTIPLE PILLS

A free service called Pilltime.co.uk, launched by an Nhs-registered pharmacy, is designed to help people who are juggling multiple medications. It receives your prescriptions direct from your doctor, and pre-packs the tablets and capsules into pouches using a machine overseen by experienced pharmacists. It’s over a hundred times more accurate than pills packed by humans, and significantly quicker.

The medicines are delivered to you via a tracked mail service and each pouch is clearly marked with the correct date and time to take the dose.

BEWARE SUPPLEMENTS

If you’re taking prescribed or over-thecounter medicines, it’s important to check with your pharmacist which supplements you can, or can’t, take with them. Interactions can occur when both the drug and supplement are absorbed by the same mechanism, act on the same cell receptors or interact with the same enzymes. Although most interactions are only theoretical or not serious, it is advisable to err on the side of caution.

Not all interactions are harmful, of course. In some cases, taking a supplement may boost the effectiveness of your treatment, or help to reduce the chance of side effects. The combination of a cholesterol-lowering statin plus a plant sterol supplement can lower cholesterol even further and may help to avoid the need to increase the statin dose. Statins are also known to lower blood levels of co-enzyme Q10, which is needed for energy production in cells, and of vitamin D, so taking these supplements may help to avoid muscle-related statin side effects. However, not every doctor agrees, so do check with your GP first.

FOOD & DRINK COMBINATIONS

Some tablets should be taken on an empty stomach and others just after food – it depends on how absorption of the medicine is affected by stomach acid, digestive enzymes, fats, and certain foods and drinks.

Some foods can have a powerful effect. Grapefruit in particular should be avoided, as it’s known to interact with a long list of drugs, including medications for high blood pressure, diabetes, high cholesterol, abnormal heart rhythms, migraine and erectile dysfunction – and the list is

getting longer all the time.

THE GRAPEFRUIT EFFECT

Grapefruit contains substances that block the production of a particular enzyme. This enzyme would usually deactivate some drugs before they are absorbed, so switching off its release allows more of the drug to pass into the circulation. The effect is irreversible and lasts for at least 24 hours, so that drinking grapefruit juice regularly, or eating the fresh fruit, can even cause overdose. Grapefruit can also affect how some drugs are broken down in the liver. Perhaps better known is that some medicines shouldn’t be taken with alcohol. For example, you shouldn’t drink when taking the antibiotic metronidazole, because the interaction will cause a build-up of acetaldehyde – a poison that produces headache, nausea, palpitations and vomiting. Alcohol also interacts with some blood pressure medications to cause dilation of blood vessels, so you may faint.

Even if you’ve read the leaflet supplied with your medicines, it’s a good idea to recheck regularly in case instructions have changed.