Thinking outside the bottle

Helping you navigate the complex and confusing world of medication

  • AS PRESCRIBED

    Why sticking with a medication can be easier said than done, and may not be the right thing

    To boost medication adherence, there are plenty of apps and products geared toward helping you remember to take your medications—from simple “days of the week” pill boxes to digital reminders, these prompts help those who struggle with medication schedules, especially if multiple medications are involved. But what if memory and organization aren’t the real issues for you? Although recalling medication instructions is an important part of adherence, that’s not the only reason people might feel challenged when sticking to a medication. Here are some other possibilities that you might experience:

  • 1. You hate the side effects

    Every medication has the risk of side effects, even over-the-counter options. The most common include nausea, fatigue, headache, muscle pains, and dizziness. While some may be mild, these and others may be bothersome enough to interfere with your daily life – interfering with your sleep, frequent urination, a foggy mind, tingling sensations, and others. When that happens, some people may stop taking their medications, or take them on a different schedule as directed, as a way to reduce side effects.

  • 2. You feel like it’s not working

    Maybe you’ve been on a medication for weeks and can’t tell if anything has changed about your condition. For example, you’re taking blood-pressure-lowering or cholesterol-lowering medication but you don’t feel any different. So, you might reason, what’s the point of staying on the medication or taking it every day if it doesn’t change the way you feel. It’ll probably still work, right?

  • 3. Your symptoms aren’t improving or are worse instead of better

    It might seem surprising, but for some people medication usage can cause symptoms to worsen, which can be very frustrating. For example, you might be taking medications to control migraine frequency, only to have them start up more often than before, or change the type of pain you feel. Maybe you’ve been prescribed an anti-inflammatory for joint pain, but now that joint feels more inflamed than ever—and joints that were once fine are now affected, too. Maybe the pain medication for your back isn’t providing any relief. Situations like this often cause people to stop their medications because they might feel like they’re doing actual damage to their bodies by sticking with their medications.

  • 4. You feel like your condition has cleared up

    If you’ve taken your medication as prescribed and your symptoms are gone, that’s likely a time when you feel like the medications did their job and you don’t need to finish the course of treatment as prescribed. For instance, some people might feel this way about antibiotics, even though doctors caution against stopping the medications when symptoms clear up and tell them to finish the full course.

  • 5. You can’t afford to fill the prescriptions

    Cost is a factor for many people, especially those who have high-deductible insurance, no insurance at all, or the medication that was prescribed isn’t covered. If you get sticker shock at the pharmacy, you have a higher risk of deciding not to take the medication. Or you might fill the prescription but “ration” the dosages to make the supply last longer, increasing the likelihood you’re not getting the benefit you need from the prescribed treatment.

  • 6. You take multiple medications already

    Research suggests that the greater the number of different medications prescribed, and the higher the dosage frequency, the more likely someone is to be non-adherent. This may be because it’s too confusing or too much of a hassle to organize and schedule all those medications, or because drug interactions are causing side effects.

  • 7. You need to take your medication multiple times per day

    Balancing your day without medications can already be a difficult enough task. Add a medication, or multiple of them, multiple times per day, and you may get the directions right a handful of times per week. Many studies have shown that the more times per day you need to take your medications, the less likely you are to take them.

    In addition to the many reasons listed that may cause you not to take your medications as prescribed, there are likely many others. If any of these sound familiar, it’s important to know that there are almost always alternatives available that can deal with your specific issue. It is important to inform your doctor or pharmacist about what’s happening and how it’s impacting your life. Then you can work together on finding medication(s) that work best for you and your lifestyle, not just for your symptoms or condition. When that happens, medication adherence is usually much easier.

AS PRESCRIBED: INSIGHTS

Is adherence to medication really that important?
The Centers for Disease Control and Prevention (CDC) estimates that non-adherence causes 30-50 percent of chronic disease treatment failures. Not taking a medication as prescribed can impact the extent to which you will receive the benefits. However, if factors such as complicated directions or the way your medication makes you feel are impacting your ability to adhere, talk with your doctor or pharmacist to see what other options are available.
Am I better off using generic medication vs. name brands?
There can be many misconceptions when deciphering the differences between brand name medications and their generic counterparts. Generic drug manufacturers submit a number of tests to support that the generic options will behave in your body the same as the brand name drug. Your pharmacist is equipped with the knowledge to help assist you in making the right choice, connect with them if you have questions about which option is best for you.
Are over-the-counter (OTC) drugs safer than prescription drugs?
Whether a drug is safe for you depends on many factors like your age, what other medications or supplements you may be taking, and other considerations. In general, don’t assume that because your drug doesn’t require a prescription you can’t have a potentially negative reaction to it. Always include any OTC drugs you may take on your medication list so your doctor or pharmacist can help ensure you’re using them safely.
Are products that have the same active ingredient the same medication?
Although various brands or generic versions of a medication may have the same active ingredient, the inactive ingredients that make up the product may be different. These are used for coloring, stability of the formula, and to help form a product like a tablet or capsule so you can take the medication. If you’ve switched products and are concerned that you aren’t tolerating the change, ask your pharmacist whether there are additional alternatives to consider.
Is it safe to add herbal supplements to my medications?
Many herbal supplements share similar mechanisms of action (the way they cause an effect) as prescription and OTC drugs, but the burden of proof for whether they are safe or effective is different. Herbals can cause side effects and interact with your other medications. It’s important to list these products as part of your medication list to avoid potential problems. Ask your pharmacist to check for potential interactions between any medications you may take, or plan to take, before mixing them with herbal products.
Can I stop taking antibiotics if I feel better?
Each antibiotic has very specific instructions for use that are important to make sure they work properly, and this includes being prescribed for a specific length of time. Even if you start to feel better before the prescribed duration, this doesn’t always mean the infection has been cleared and that the threat of sickness has completely subsided. Talk with your doctor or pharmacist to ensure you fully understand the treatment plan of your prescription.
  • SIDE EFFECTS

    With side effects, one size doesn’t fit all

    When you’re starting a new medication, you might be told about the potential side effects by your doctor, pharmacist, or other healthcare provider. Even if they seem minor, it’s important to build some awareness around how you feel—physically, mentally, and emotionally—as you ease into taking your medications.

    Here are key considerations to keep in mind about potential side effects:

  • SIDE EFFECTS

    Every body is different

    Maybe you’re starting a pain medication that worked very well for a friend, and helped alleviate her symptoms. But for you? Not so much. The pain might still be there, and now you’ve got other issues, too, like headaches or nausea or constant dry mouth. Why are these new problems happening to you when they weren’t a factor for your friend?

    The fact is, everybody has unique reactions to medications—good and bad. Medications are complex and our bodies are complex. That’s why there are usually multiple options for your condition, so that if you experience side effects or the medication isn’t working, you can try something else.

    It’s also good to keep in mind that someone else’s side effects shouldn’t make you hesitant to try a medication that’s been prescribed. For example, just because your friend may have become nauseated by a particular medication doesn’t mean that you will, too.

  • SIDE EFFECTS

    Some side effects may feel unrelated to your medications

    You take a medication for migraines and a few days later, you have trouble concentrating at work, or feel pin-pricks on your hands or back, there are muscle spasms in your leg, or you feel anxious and irritable. Are those effects related to your medication or simply coincidental?

    Pinpointing whether medication is causing changes in your mental, physical, or emotional state is a good topic for you and your doctor. But in the meantime, just be aware that there can be a variety of side effects caused by your medications, even if they aren’t the most common ones mentioned by your doctor or pharmacist.

    Even if you’ve been taking a medication for a long time, new side effects can happen due to changes in your body. If you start to experience new symptoms, and you take medications, it’s always a good idea to inquire if these symptoms could be caused by one of the medications you’re taking. Often we don’t think of medications as the cause of a new problem, but medications are complex and our bodies are complex, so it’s important to make sure your health care provider considers this possibility.

  • SIDE EFFECTS

    How you take medication matters

    There’s a reason medication instructions can be so, well, instructive. Take with meals, don’t take with meals, take every 12 hours, take at night, and so on. These directions are designed to increase the efficacy of how the medications work, and to limit side effects whenever possible.

    For example, some pain medications may cause stomach upset or make people nauseous. Taking the dose with food may be an option to limit this side effect. Or, your blood pressure medication may make you use the bathroom more. Taking the dose in the morning can help prevent you waking up throughout the night to use the bathroom.

    In addition, some drugs may work better depending on the time of day they are taken. For example, some cholesterol medication may work best if taken at night, the time of day when your body is making cholesterol.

  • SIDE EFFECTS

    Talk with your doctor or pharmacist

    Taking the time to jot down anything that feels new—even if it seems completely unrelated to your medical condition and treatment—can be useful for seeing whether you’re dealing with unexpected side effects.

    Simply put, every medication has potential side effects. These can range from benign to life-threatening, and some effects are far more noticeable than others. That’s why it’s important to stay aware of changes while you’re on your medication, and let your doctor or pharmacist know what’s going on.

    Always let them know every medication you’re taking, from every prescriber, including over-the-counter drugs, supplements, and herbals. That way, you can work together to adjust treatment, and possibly find a medication that addresses the same issue, without the same side effects.

SIDE EFFECTS

One size doesn’t fit all

It's important to pay attention to how you're feeling on your medication. Learn more about side effects and medication in this short video.

SIDE EFFECTS: INSIGHTS

What’s the most common form of side effect?
The most common side effects from medications are nausea, upset stomach, dizziness, and fatigue. For medications used on the skin, irritation may be commonly experienced. You may be experiencing an allergic reaction to your medication if it causes a rash or itching. In severe cases, an anaphylactic reaction can occur which can cause trouble breathing. It’s important to recognize when your medication is negatively impacting your health and to ask for an alternative when needed.
Are all side effects harmful?
Not all side effects are harmful. Take finasteride, for example. Developed in 1992, this drug was introduced to treat enlargement of the prostate. Today, finasteride is used to treat male pattern baldness, a side effect that lead to the drug being developed for this use. Most side effects are not desirable though, so if you are concerned that your medication is interfering with your daily life or affecting your health negatively, be sure to speak with your doctor or pharmacist.
How will new medication interact with what I’m currently taking?
Combining two or more medications, or combining medication with OTCs or supplements, can come with its own set of side effects. Iron supplements, for example, interact with a long list of drugs used to treat a variety of conditions. Two drugs that you may tolerate just fine independently could cause side effects when combined together. Inform your doctor or pharmacist if you are on any other treatments before being prescribed additional medication.
Will new medications affect the way I sleep?
Some medications can interrupt your sleep, making it hard to sleep through the night. Some medications, including those for high blood pressure and asthma, can cause cases of insomnia, while others can lead to more extreme symptoms, such as sleepwalking or nightmares. Consult with your doctor or pharmacist if you notice any trouble sleeping or odd behavior in your sleep patterns while taking medication so they can help assist you in finding an alternative.
Will my medication affect how I use the bathroom?
Many over the counter and prescription medications can cause changes in urine color, smell, and frequency, while others may result in diarrhea or constipation. These side effects may be expected, or they may be a signal from your body that something is amiss. Make sure to bring up any concerns to your doctor or pharmacist so they can assist you with side effects that seem out of place.
Can my medication affect my eyesight?
Certain prescription drugs and even a few OTC remedies come with potential visual side effects. Antihistamines commonly used to help with allergy symptoms and anti-inflammatory drugs like corticosteroids can lead to blurred vision and cataracts, respectively. Talk with your doctor or pharmacist if you experience visual side effects from your medication, and be sure to schedule annual eye checkups if your prescribed medication has the potential to impact your vision.
  • LIFESTYLE

    Making medications work better for you

    Medications each have a variety of mechanisms of action, some well understood and others not, which is how they’re able to “target” specific systems or receptors in your body and provide you benefit. But even when they’re doing exactly what they’re supposed to, your medications may work even better with a little help from you.

    What you eat and drink, how often you exercise, whether you get enough quality sleep, and how you handle stress or feeling depressed can all play a role in your health—and often, focusing on improving those behaviors can go a long way toward boosting a medication’s efficacy.

  • The ripple effect

    Remember that medications aren’t a replacement for lifestyle changes—we’re not quite at the point where you can reap the benefits of exercise and healthy eating through a prescription. Instead, medications are usually meant to complement healthier behavior and work together with your body in a meaningful way.

    For instance, when your stressed and not getting enough sleep, your body’s ability to ward off or get rid of an infection is reduced. While medication may help reduce the infection in your system, if you don’t take the time to relax, rest, and sleep, the infection can come back or symptoms may linger longer than necessary. With better stress management and sleep your immune system improves, which can make your medication more helpful…or help prevent certain illnesses all together.

    The ripple effect of lifestyle changes and enhancing the response to medications can create more benefits than you might think. For instance, consistent improvement in nutrition and activity may lead to better moods, less joint pain, clearer thinking, and a greater sense of resilience and wellness—outcomes that may not seem related to your medication and lifestyle changes at all, but result nonetheless as happy side effects of good behaviors.

  • One change, many results

    Has your health care provider ever commented “Try to exercise more,” “It’s important to exercise regularly,” “Make sure to watch your diet,” or something along those lines? They say that to everyone, right?! While regular exercise and a healthy diet is good practice for everyone, there may be additional reasons WHY making the extra effort to change the amount you move and what you eat is important. Another major benefit of embarking on lifestyle changes is that you may be able to affect the amount or type of medication that you take.

    For instance, for people who have high blood pressure, if they are able to lose some weight and reduce the amount of salt they consume, the dose of medication or even the total number of medications they take can be reduced —based on their doctors’ recommendations, of course. Making lifestyle changes can produce improvements in measures like weight, cholesterol numbers, body fat percentage, resting heart rate, and other markers.

  • Steps toward stability

    The same is true for Type II Diabetes. Losing weight and improving what you eat can reduce the number or doses of medications needed to keep your blood sugar under control and delay complications related to the condition. One example is a diabetes medication like insulin. For some people, losing weight can improve the body’s response to insulin, which means less medication or, in some cases, eventually stopping it altogether if the doctor says it’s safe to scale back and discontinue use.

    Even conditions that aren’t chronic can follow this path. For instance, you may be able to reduce use of pain medication if you can lower the amount of inflammation in your body through strategies like healthy eating, stretching, and exercise.

    It’s important to work closely with your doctor if you’re making changes to your diet and exercise routine while taking medication. Because the dose you’re taking may start working even better, you’ll need to recognize the effects of a strong dose. In the examples of high blood pressure or diabetes, too much medication can cause your pressure to drop too low, making you dizzy or lightheaded, and increasing your risk of falling.

  • Start where you can

    Making large-scale, wholesale changes to your life is never easy—there’s a reason why about 80% of New Year’s resolutions are abandoned by February. But the good news is that even smaller, incremental changes can add up to major benefits.

    You can start by adding some vegetables to meals, walking during your lunch hour, and going to bed about seven to eight hours before your alarm. Even taking a few deep breaths every hour has been shown to have a big advantage for de-stressing.

    If you’re taking medications for Type II Diabetes, high blood pressure or cholesterol, and even your mood, small changes in your diet, exercise routine, and time to relax, can really compliment the purpose of your medications.

LIFESTYLE

Making medications work for you

There’s a lot that we can control when it comes to how well medications work with our bodies. Learn more about how your health, lifestyle, and medications go hand in hand.

LIFESTYLE: INSIGHTS

How will my medication change my activity level?
Certain medications can inhibit physical activity by altering ordinary functions of the body. Beta blockers, for example, are commonly prescribed for high blood pressure and heart disease. These medications can prevent the expected increase in heart rate that occurs naturally with exercise, potentially making it difficult to participate in high-energy exercise. Consult with your doctor or pharmacist if you believe your medication is disrupting your physical activity and they will work with you to find a solution.
Can I eat grapefruit with my medication?
Grapefruits and some related fruits contain a class of chemicals called furanocoumarins. These chemicals can slow down the way enzymes in the gut and liver normally break down some medications, increasing levels of the drug in your system and therefore increasing the likelihood of side effects. Make sure your doctor and pharmacist know if you regularly consume grapefruit or other similar fruits. They can help you decide whether it's safe to consume while on certain medications, or if your dosage may need adjusting.
How does alcohol factor in with my medication?
Your liver is responsible for breaking down much of the food, drinks, medications, and alcohol that you consume. In some cases your medication and alcohol are metabolized by the same enzymes, potentially competing for the enzyme’s activity. This can cause an interaction and potentially less effective—or even toxic—results. Be sure to ask your doctor or pharmacist if consuming alcohol with your medication is safe before enjoying your night out.
Will dairy products affect my medication?
Dairy products may interfere with the efficacy of certain antibiotics. Calcium, magnesium, and casein (a protein found in many dairy products) may delay or prevent absorption of some of these drugs. If you are prescribed antibiotics, ask your doctor or pharmacist if you can consume dairy products, or any calcium supplements, while taking them.
Can I drink coffee with my medication?
The caffeine in coffee, other beverages, and energy supplements is processed by the same liver enzymes as many drugs. This can interfere with the way active ingredients in certain medications are broken down, increasing the level of drug in your body. Caffeine can also increase your blood pressure and heart rate, working against certain heart medications. Ask your pharmacist how much caffeine is safe to consume if you are taking medications.
How are my metabolism and medication related?
Many products we consume, environmental conditions, and our health status can affect our metabolic activity. Also, as people age, the enzymes responsible for metabolism decrease in activity. Because of this, the dose required of many drugs to cause the desired effect is less in an older adult. Check in with your doctor or pharmacist routinely so they can check that you’re still on the right dose of your medication.
  • A BETTER DOCTOR VISIT

    Patient’s guide to a more effective doctor visit

    Most patients feel that time crunch that comes with doctor visits—as soon as the physician walks through the exam room door, the imaginary stopwatch begins.

    According to the National Institutes for Health, the average primary care office visit is about 17 minutes, and an average of 6.5 topics are brought up during that time, giving less than 2 minutes of focus per topic.

    You may experience more or less time with your health care provider, and it may not be as short when visiting a specialist, but it certainly highlights the need to be as efficient as possible in addressing your needs, getting your questions answered, and communicating important health info like medication side effects or making sure your medications are still working or needed.

    Here are five strategies for making your next visit more effective:

  • 1. Write down your questions in advance

    Keep a running list of questions in a notebook or on your phone so you can add to it for at least a few days before your visit. If your list is way too long to cover in one visit, let the doctor’s office know that you’d like a longer appointment if possible, and also prioritize the list just in case it isn’t.

  • 2. Get ready to be honest

    Your doctor doesn’t benefit from hearing what you think you should say, instead of what’s really going on. Maybe you stopped taking your medication because it made you nauseated, felt ineffective, killed your libido, caused mood changes, was dosed too many times per day, or is too expensive. Getting the right medication for you—not just for your condition—is incredibly important, so if you need an alternative, speak up.

  • 3. Compile all your medication information

    One of the first experiences you have when you get to your exam room is having an assistant ask you about your medications, as they enter them into an electronic record. Oftentimes the list that ends up in your record isn’t completely accurate because the office staff couldn’t find the right match in the system, you may have forgotten the dose or exact name of med, or you left out some medications that you didn’t think were relevant to the particular visit – maybe because it was prescribed by another provider, it’s something you only use now and then, it’s a topical med, etc.

    It’s important to know that the system your doctor or nurse is inputting your medical history into doesn’t usually have information about your medications other than what you tell them.

    Be prepared for your doctor appointments with information regarding all of the prescription medications you’re taking including topicals, inhalers, eye drops, etc, from all of your health care providers. Also inform them of medications you may only take occasionally. Even if you don’t use a medication every day, it is still an important part of your story. Over-the-counter drugs, dietary supplements, and herbal supplements are important too, as these can cause potential drug interactions just like prescription drugs.

    The medications you’re taking can play a major role in how you are feeling, in determining the best and safest treatment choices for you, and potentially as a cause of your symptoms.

    3. Compile all your medication information

    One of the first experiences you have when you get to your exam room is having an assistant ask you about your medications, as they enter them into an electronic record. Oftentimes the list that ends up in your record isn’t completely accurate because the office staff couldn’t find the right match in the system, you may have forgotten the dose or exact name of med, or you left out some medications that you didn’t think were relevant to the particular visit – maybe because it was prescribed by another provider, it’s something you only use now and then, it’s a topical med, etc.

    It’s important to know that the system your doctor or nurse is inputting your medical history into doesn’t usually have information about your medications other than what you tell them.

    Be prepared for your doctor’s appointments with information regarding all of the prescription medications you’re taking including topicals, inhalers, eye drops, etc, from all of your health care providers. Also inform them of medications you may only take occasionally. Even if you don’t use a medication every day, it is still an important part of your story. Over-the-counter drugs, dietary supplements, and herbal supplements are important too, as these can cause potential drug interactions just like prescription drugs. The medications you’re taking can play a major role in how you are feeling, in determining the best and safest treatment choices for you, and potentially as a cause of your symptoms.

  • 4. Don’t forget to talk about your medications during the time with your doctor

    Often, once the doctor is in the room, the visit will focus on the symptoms you’re experiencing, treatment options, and necessary tests to take. What medications you’re using and what role they may play in the symptoms you’re experiencing may get only a sliver of time, if any at all. But your experience in taking medication—especially if you’re having challenges taking your medications as directed, concerned about side effects, or even just wondering if the medications are working, whether your dose needs to change, or even if it’s time to stop your medications—is a crucial part of the conversation. So, make sure to ask about your medications—and that includes over-the-counter drugs, herbals, and dietary supplements.

  • 5. Ask about follow-up instructions

    Sometimes, patients get so focused on what’s going on during the office visit, they neglect to get more direction in terms of what happens next. For example, do you need to come back for a follow-up? If so, when, what’s dictating the time? How will you know if your treatment is working? Do you need to take lab tests to know about the effect or potential side effects of a medication? What should you do if there are side effects to your treatment that are troubling? Talk next steps before the visit ends.

    In general, the most important strategy is to be open to communication about your needs, fears, and reactions. Using that 17 minutes to collaborate with your doctor on a treatment plan that works for you is definitely time well spent.

A BETTER DOCTOR VISIT: INSIGHTS

Do my medications ever need adjusting?
Very few medications require little attention once they are started. Everybody is different, and although your doctor or pharmacist is trained in what they do, details can sometimes go unaccounted for. Weight loss, dietary alterations, and changes in age are just a few examples of changes over time that could affect the dosage of a medication you need. Work with your doctor or pharmacist to make sure you are monitoring your response to your medications properly, so you can make sure you’re taking a safe and effective dose.
How can I achieve an open dialogue with my doctor or pharmacist?
The necessary first step to getting the most out of your doctor’s visit is to be honest with them. You may not like to admit much of your personal health habits, but your health care provider needs to know about these, and other lifestyle matters, to ensure you get the best outcomes from the care they provide.
How can I make sure all of my questions are answered at my next appointment?
Doctors have a limited amount of time for office visits, so setting an agenda outlining what to go over can help them stay focused with their patients. Taking the time to set your own agenda before visiting your doctor or pharmacist is a great way to make sure the things on your mind don’t go ignored.
Are there any follow-up questions I should ask my doctor?
Before you leave, be sure you understand what needs to happen next. If any tests are run, ask for better clarification on the results, what they mean, and whether you need to have the test repeated after a period of time. If you have just received a diagnosis, ask for more details on treatment options and how you will know if a treatment is working for you or not or what the goals are.
What should I do if I feel unsatisfied with my visit?
Ultimately, if you feel that you have not established a rapport with your doctor or if they aren’t listening to your concerns, it may be time to make a change. Seeking referrals from others can be helpful, or researching doctors online can be useful to help narrow down your choices. Finding a doctor who asks what’s important to you, listens, and shows initiative in the care they provide can be one of the most important steps you can take towards a happier and healthier life.
Is it ok to ask my doctor “why?”
It is extremely important to understand what the diagnosis your doctor made means, why she picked a certain treatment, how you’ll know if it’s working, and the rationale behind any tests she may have ordered. If you don’t fully understand any details during or after you visit, don’t hesitate to ask.

THINKING OUTSIDE THE BOTTLE

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Navigate the world of medication with confidence with our informational 40 page booklet.