Prescription for Trouble: Ignoring Label on Medicine
Many New Year’s resolutions can keep you from needing prescription medications, including the commitments to stop smoking, exercise regularly, limit alcohol and fat intake, and lose weight (if you’re overweight). But if you already have, or develop, problems that require prescription drugs, we’d like to suggest an additional resolution for 2002: Take your medication exactly the way it was prescribed.
Misuse of medications (often referred to as noncompliance or non-adherence) is widespread. Nearly 40% of antibiotic prescriptions are stopped prematurely. And among people who use drugs to treat chronic medical conditions, studies suggest that less than half are taking their medications as prescribed. Noncompliance is especially common among patients whose medical problems--though serious--do not cause symptoms (for example, high blood pressure or high blood cholesterol).
In a study of men who had suffered a heart attack, those who took less than 75% of their medication were over 21/2times more likely to die within a year of their heart attack than men who followed their prescription instructions more faithfully. The chance of dying was more than doubled in women who did not adhere to their medication regimen, compared with those who did.
Medication misuse leads to other problems also. Stopping antibiotics before the prescription is completed can expose you to a much more severe recurrent infection. Even though your symptoms may have improved or disappeared, the most resistant bacteria may still be present. Stopping the antibiotics prematurely allows these bacteria to multiply, and they may no longer respond to the same antibiotics. Often, stronger, more expensive and more dangerous antibiotics are then necessary to treat the infection.
There is a long list of reasons why patients don’t take medications properly, including forgetfulness, confusion about how to use the drugs, lack of understanding about why a drug is necessary, and cost (some people skip doses to save money; ironically, this decreases drug effectiveness and exposes these patients to expensive complications). Many people stop their medications intentionally; they don’t “feel” different, so they think the drugs aren’t working. Still others stop taking the drugs because of side effects that do make them feel different.
If you use prescription drugs, and you are not taking them as directed, making a resolution to adhere to the prescribed regimens is one of the best things you can do for your health. Here are some simple commitments you should include in that resolution.
* Learn everything you can about every drug you are taking. Talk to your doctor and your pharmacist, and read as much as you can about the medications. You should know how the drug works and what the possible side effects are. Also, make certain that it is an appropriate medication for you to take. Some medications should not be prescribed to children, some to those who are elderly, and others to those with medical problems such as kidney or liver damage. (A recent study revealed that the use of inappropriate medications is more common than many people realize. Among a group of men and women age 65 and older, more than 20% were found to be receiving at least one drug considered to be potentially inappropriate.) Ask your doctor if there are any alternatives to using a drug; if not, ask your doctor to prescribe the safest and least expensive drug that is likely to achieve the results you need.
* Take every drug exactly as prescribed. Find out the best time to take your medication, whether it should be taken with food or on an empty stomach, and then stick to that schedule. Set up cues to prevent missed doses (set alarms, for example, or tape a paper reminder to your toothbrush or a mirror). If you use several drugs and have a complicated dosage schedule, purchase one of the handy medication carriers that have been developed to simplify the task (ask your pharmacist to help you choose a device).
* Talk with your doctor before stopping any drug. Abruptly withdrawing certain medications can cause dangerous--and potentially life-threatening--problems. In people with heart disease, for example, suddenly stopping beta-blockers increases the risk of sudden death and heart attack. Tell your doctor if you are skipping doses. Without that information, your doctor might assume that your drug isn’t working; this could lead to a dangerous increase in dose or the addition of an unnecessary drug.
* Purchase all of your prescription medications from the same pharmacy, and make sure that the pharmacist keeps a computerized “profile” that lists all of the drugs you are taking, both prescription and over-the-counter. This is the best way to avoid a dangerous interaction between two drugs that should not be taken together.
* Follow all warnings on the label. For example, some medications cause side effects that are incompatible with safe driving; others are dangerous when combined with alcohol.
* If cost of medications is a problem that keeps you from taking drugs properly, ask your doctor and pharmacist if a less expensive alternative is available (generic drugs cost a fraction of their branded counterparts). If you must take several medications on a regular basis, check prices at mail-order pharmacies. Finally, find out if you are eligible to receive free medication through a Prescription Drug Patient Assistance Program. A directory of participating pharmaceutical manufacturers is available through the Pharmaceutical Manufacturers’ Assn. Call (800) 762-4636 or go to www.phrma.org.
While you are doing all of these things to adhere to your medication resolution, don’t forget the other things you can do to protect your health and, possibly, eliminate the need for some of the drugs you are taking: Maintain a healthy weight, control your fat intake, eat lots of fruits and vegetables every day, exercise regularly, avoid unnecessary stress, and, if you smoke, stop. That’s our prescription for you. We wish you a happy and healthy holiday season and the best year ever in 2002.
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Dr. Jonathan Fielding is the director of public health and the health officer for the Los Angeles County Department of Health Services. Dr. Valerie Ulene is a board-certified specialist in preventive medicine practicing in Los Angeles. Send questions by e-mail to ourhealth@dhs.co.la.ca.us. Their column appears the second and fourth Mondays of the month.
