Have you been prescribed a new medication or been on the same medication for years? Maybe you’re adding a vitamin to your pill regimen or taking an over-the-counter medication for a new symptom.
These are all important reasons to have your list of prescriptions, over-the-counter medications and supplements reviewed by a health care professional.
Medicines are meant to help us live longer and healthier. Still, there are dangerous and costly consequences to taking medications incorrectly or mixing certain drugs and supplements, said Pharmacist Gina Harper, clinical coordinator of pharmacy services for UCHealth Poudre Valley Hospital.
“It is important for everyone to remember that medications should be used at the smallest dose for the shortest amount of time,” she said. “And another mantra: more is not always better.”
Harper, who performs medication reviews through the UCHealth Aspen Club free medication review program, discusses the importance of a medication review, how often it should be done and concerning issues that may occur.
“The biggest reason to have your list of medications assessed is to try and pare down or reduce the amount of medicine you are taking,” Harper said.
For people on a Medicare drug plan, it is a requirement for you to have access to a medication review if you meet certain requirements. Still, a yearly review of medications is also important for anyone taking multiple medicines.
Doctors or pharmacists are qualified to perform medication reviews. However, unlike a pharmacist, your provider can act on any prescribed medication changes that might come up during a review.
“If you see your provider annually, that is a good time to have your medications reviewed,” Harper said. “If I have concerns about a prescription medication during a review, I’ll send that person back to the prescribing doctor to talk to them about what I found.”
Pharmacists cannot prescribe most medications but are very knowledgeable about how medicines work and interact with others.
Individuals should also be reviewing their medications. Harper recommends that people write down the prescriptions, over-the-counter drugs and vitamins or supplements they take. It’s also important to note the dosage size for over-the-counter medicines and vitamins.
When Harper performs medication reviews, she has the person bring in the bottle for each medicine they are taking because the information on bottles helps her identify common issues.
Overlapping supplements. People often take several supplements with overlapping ingredients, so they often get too much of the daily recommended allowance for that particular “good thing.”
“What I commonly encounter is people are not comparing the ingredients on supplement bottles. They may be taking a multivitamin, bone health supplement and Vitamin D. Then they end up way over their daily recommendations,” she said. “Vitamin B and D tend to be the ones most overdone.”
Continuing on a supplement when it is no longer needed. You may start something a year ago, like glucosamine for knee pain, and are still taking it even though you’ve since had that knee replaced, so you don’t need to take that supplement anymore.
Taking a supplement that interferes with a prescription. Some supplements, such as Vitamin E and Ginkgo, increase your risk of bleeding, just like blood thinners do. Someone on blood thinners should avoid supplements that increase the risk of bleeding.
“During a medication review, I like to see what they are taking and if it makes sense to continue to do so,” Harper said. “People can spend hundreds of dollars per month just on supplements.”
Asprin. There are new recommendations regarding a daily dose of baby aspirin for cardiovascular health.
“I see many people who have remained on (baby) aspirin even though those recommendations have changed,” Harper said.
Older adults who are not at an elevated risk for heart attack or stroke should not be taking a daily baby aspirin, according to the new guidance from the U.S. Preventive Services Task Force. That’s because the bleeding risks associated with taking daily baby aspirin increase as people age. Those risks can outweigh the protective cardiovascular benefits for someone who has never had a heart attack or stroke. Talk with your doctor about the benefits of baby aspirin versus the risks.
Sleep aids. Another concerning issue Harper sees in these reviews is older adults taking over-the-counter sleep aids (this does not include melatonin).
Medicines like Tylenol PM have diphenhydramine, which is a “big no-no” for adults over the age of 65.
“Diphenhydramine hides in many over-the-country sleep aids,” Harper said. “Which is directly tied to increase risk of falling, memory loss and urine retention (in adults 65 and older).”
The info on diphenhydramine is part of the American Geriatrics Society Beers Criteria, a reference tool used by health care professionals that is a compendium of medications potentially to avoid or consider cautiously because they often present an unfavorable balance of benefits and harms for older people.
Gastric reflux medicine. Harper said she sees people using over-the-counter gastric reflex meds, like Prilosec, not prescribed by a gastroenterologist for an ulcer.
“Being on those meds long term can impair your ability to absorb other vitamins, and they can cause other problems,” Harper said. “This goes back to my advice that you should take the smallest dose for the shortest time.”
She recommends people speak to their doctor if it has been prescribed, and if they plan to stop taking the medication, not to do it “cold turkey” but rather taper off to avoid uncomfortable gastric issues.
Pain relief. Harper often hears from older adults that Tylenol doesn’t work for them, so they take a nonsteroidal anti-inflammatory drug (NSAID) like Aleve or Motrin. If that person also has high blood pressure, the combination can worsen blood pressure, amongst other problems.
Lifelong medication treatment. “Unfortunately, the thing I see a lot is that something gets started, and it becomes a therapy for life,” Harper said. “If a patient never got better on that drug, then maybe it should be removed or replaced, especially if there are side effects, like weight gain, that could lead to other issues like high blood pressure or diabetes.
“A drug that is not treating the underlining disorder and is also causing additional problems is likely not a drug they should be taking.”
Treating the side effects of prescription medications. When a medicine has side effects that cause that person to take additional drugs to solve the new issues, then Harper said it’s time for them to return to their doctor to ask whether a different care plan is appropriate.
She also sees the opposite: People do not want to take their medication for their health condition because they fear the side effects. For example, people often hear about the muscle pain that statins can cause, so fear interferes with them taking a statin. Studies show that muscle pain or weakness is common in adults, regardless of whether they take a statin tablet. Harper said to talk with your doctor about your treatment plans, so you understand better if your risk for a heart attack or stroke is greater than the risk for adverse side effects from statins.
Not knowing enough about WHY they’re taking a specific prescription. “It’s always a good idea to ask questions,” Harper said. “If you don’t understand the first time, ask two or three more times. If you don’t understand why you need to take something, you’re less likely to comply with it, which will drive down positive outcomes and may cause more problems.”
Keeping quiet about compliance. Harper stresses the importance of being honest with your doctor about your prescription medication compliance.
For example, you show up in your doctor’s office with high blood pressure, but they don’t know you’ve only been 50% compliant with taking your blood pressure medication. They might add another drug or increase your dose, which adds unnecessary risks.
Along with compliance, be honest about the side effects and the financial burden of the prescription, as there might be other options out there.
“They assume you’re filling it and taking it as prescribed,” Harper said. “No one wins in these scenarios, so ask questions with an open stance of curiosity and be honest.”
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