Multiple medications can multiply risks

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Taking several types of medications can be challenging. But this is something you have to get right. If you don’t, you may have unwanted side effects, or you may not properly treat your chronic condition.

“I see people who average 15 medications, and it’s very difficult for them to juggle that many pills,” said Joanne Doyle Petrongolo, a pharmacist at Harvard-affiliated Massachusetts General Hospital.

Polypharmacy — defined as taking five or more medications (including prescription medications, over-the-counter products and herbal supplements) or taking more medications than medically necessary — comes with a number of risks.

Drug interactions and side-effects

Chief among the risks are harmful drug interactions.

“As the number of medications increases, the potential for drug interactions goes up, and there’s an increased potential for side effects that can lead to emergency room visits and hospitalizations. For example, if you take several blood pressure medications, you may develop low blood pressure that could cause you to faint and be hospitalized,” said Petrongolo.

Polypharmacy also makes it tough to tell if a particular drug is causing a side effect. For example, you may suspect that one of your medications is causing unsteadiness, fatigue or insomnia, but you’ll have to do some detective work to figure out which one is the culprit.

Other risks include trouble taking your medications as prescribed, because the regimen may be too confusing to follow; unnecessary drug expenses; and avoidable hospitalizations.

If you’re having side effects, Petrongolo urges you to contact your doctor’s office. And if you’re having a hard time managing your drug regimen, she suggests that you talk to your pharmacist.

“Don’t wait until you are drowning in a sea of pills. [Pharmacists] can provide medication counseling and make recommendations to improve your regimen. For example, a pharmacist’s recommendation may enable you to take different or fewer medications,” she said. “You may be able to decrease your pill burden or save money.”

Use one pharmacy

Petrongolo also suggests that you get all of your prescriptions filled at one pharmacy. “The pharmacist will be able to run a drug interaction check on your medications and will know if doctors are prescribing conflicting medications,” she said.

Every time you have a new prescription filled, ask your pharmacist what the drug is used for, how and when to take it with other medications, and whether it will interact with other medications.

Get to know the look of a pill, and talk to your pharmacist if a new batch looks different. 

To manage medications, start with an up-to-date list that includes what each medication is used for, the proper strength, and dosing instructions. That will be helpful if you forget, or if a family member helps you with your regimen.

Use a pillbox with multiple compartments, perhaps labeled breakfast, lunch, dinner and bedtime. Many different types of pillboxes are available, from simple plastic boxes that you fill each week, up to high-tech electronic dispensers, complete with alarms and reminders sent to your smartphone.

Your pharmacy may also offer a handy dispensing method, known as bubble packing, which packages single doses of several medications in one plastic pack.

If you’re tech-savvy, tablet and smartphone apps can remind you to take your medications and can even track your adherence.

“One tool isn’t necessarily better than another. It’s best to assess the specific needs of the patient to choose the best medication management system [for them],” said Petrongolo.

Include supplements

It’s crucial to tell your pharmacist or physician if you take over-the-counter drugs, vitamins or herbs. “They increase the overall pill burden, and some of these products may interact with prescription medications,” warns Petrongolo.

For example, ginseng, ginger, ginkgo biloba and garlic can increase the potential of bleeding, especially if taken with the blood thinner warfarin (Coumadin). St. John’s wort can interact with antidepressants like fluoxetine (Prozac), sertraline (Zoloft) and paroxetine (Paxil). Calcium supplements can interact with thyroid medications like levothyroxine (Synthroid) and decrease their effectiveness.

Ask a pharmacist about interactions before starting any new nonprescription drugs. And remember to either bring a list of your medications and supplements to your annual doctor appointment, or simply bring the actual pill bottles with you.

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