By John Messmer, M.D.
“Tell me about any medications you take.” It’s a simple request asked of people whenever they go to a physician’s office or hospital. Most Americans are taking at least one prescribed or over the counter (OTC) medication or supplement. Can you name the medications you take? Do you know what each medication is for?
Maintaining a list of all the prescribed and OTC meds you use is a great idea, but it’s also very important to know why you use each one. Many medications have multiple uses. Some blood pressure drugs may be prescribed to protect the heart and kidneys rather than to lower blood pressure, for example.
Also important is having an understanding of the likely side effects. Most pharmacies dispense prescriptions along with a patient education handout listing warnings of possible side effects, and the Internet is filled with good and bad information about problems with medications. But there is a world of difference between possible and likely side effects. You should ask your physician how likely you are to have a side effect and what to do about it. Most people can take most medications without significant side effects.
Research has lead to the development of very powerful medications for many serious health conditions. Some of those drugs do have potentially serious side effects, but in every treatment situation, physicians try to weigh the benefit vs. the risk before prescribing them. This is where your involvement in the decision making process can be very important. Knowing the what and why of your current medications and having a frank discussion about any new medications can increase your safety and allay any concerns you might get from other sources.
If a little is good, a lot is better — or is it? It is very important to understand if it is acceptable for you to self-adjust your medications. Some directions are written to allow it. “Take one or two tablets every 4 to 6 hours as needed for pain” means the patient may decide how many and how often to use the medication within the limits set on the label. On the other hand, if it says “One daily” it means only one and every day, no more or less.
Sometimes people stop their medications when the problem being treated is under control. That is a decision to be made in discussion with your doctor. Infections are treated for specific lengths of time to assure that the cause of the infection is gone, for example. Chronic conditions like high blood pressure and diabetes may be controlled by the drugs, and stopping them may allow the problems to get worse. But it might be possible to discontinue medications if the underlying cause of the problem is fixed. That is something to discuss with your physician before stopping the medication.
If your health problem resembles someone else’s health problem, never share medications. It takes pharmacologic knowledge and medical experience to know if the problems are indeed the same and whether or not the medication is acceptable for the other person. For example, some heartburn drugs may not mix well with certain antidepressants or heart drugs. If you share your medications with someone else, you are practicing medicine without a license.
“Natural” chemicals and synthetic chemicals are both chemicals. At the level of your body’s cells, there is no difference. But a “natural” treatment may not have been studied and its purity is not necessarily checked by anyone. Before embarking on an all-natural approach to your health, have a discussion with your physician. Remember proper diet and regular exercise are the most natural treatments.
If cost is an issue, do not cut pills or skip days unless your physician has told you to do so. If you need 20 mg of something, it might be OK to cut a 40 mg pill in half but some pills are made in a way that requires they stay intact to work correctly. Ask about generic drugs, which usually work as well as the branded drugs, although there may be times that no generic option exists. Most pharmaceutical companies have programs to help defray the cost of their medications for those who cannot afford them.
TV ads are not a good source of medication information. Commercials are not balanced. They are designed to motivate you to purchase something. For prescriptions drugs, their purpose is to get you to request a particular medication from your doctor. But no TV commercial can present in 30 seconds all the information you need to make an informed decision. A high level of skepticism is important when viewing drug ads.
If you see several physicians and other health care providers, your medication list is an important part of medication reconciliation. A hospital admission, an emergency department visit, seeing a specialist — each is a time when medications might be changed, either intentionally or because of formulary restrictions. Until we have a nationwide system of compatible electronic records, you and your primary care physician should partner to assure the accuracy of your medication list.
We have come a long way in our ability to treat and prevent medical problems, but medication use is much more complex than it used to be. Your understanding begins with talking about your prescriptions with your doctor.
John Messmer, M.D., is an associate professor of family and community medicine at Penn State College of Medicineand a staff physician at Penn State Hershey Medical Center.