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Prescription for success: Ask your pharmacist

August 12, 2010 By: Nadia Category: HealthCare, Medicine Advice, Medtipster, Prescription News Source: LA Times – Author: Karen Ravn

Here’s a list of questions that you should pose before taking your medications home.

You’re tired, hungry, cranky, and you’ve been waiting in line forever. Now your pharmacist is offering to discuss your new prescription — the last thing on earth you want to do.

Do it anyway.

The warnings and descriptions on the obligatory information sheet are meant only for a general audience. Your pharmacist can offer pertinent details — and emphasize the aspects most important for you.

So don’t go home without getting answers to these questions:

What is the medication for?

In other words, make sure you get what you think you’re getting. Mistakes happen. If the medication the pharmacist prepares for you is a fertility drug and what you wanted were birth control pills, this is a prime time to find out.

What is the name of the medication?

Physicians don’t always tell patients the name of the drug they’re prescribing, and patients don’t always remember when they do. It’s not enough to know you’re taking “these big fat horrible-tasting pink things” twice a day. Your dentist, your insurance agent, the on-duty physician in an ER — all might need the actual name of your medication. You should know it.

How should you take the medication?

Some medications should be taken with food. Some should be taken only when you’re standing up. Some (especially those that are enteric-coated or designed for controlled release) can be harmful — even fatal — if they’re crushed. Only if you know the best way to take your medication can you hope to have the best results.

When should you take the medication?

Some drugs should be taken in the morning. Some should be taken at bedtime. And with some, precise timing is more crucial than with others. For example, if you’re supposed to take a pill twice a day, it would probably be OK to take it at 8 a.m. and 10 p.m. But that schedule wouldn’t be OK if you’re supposed to take a pill every 12 hours.

What is your medication supposed to do — and how soon is it supposed to do it?

If you’re coughing and sneezing and feeling achy all over, should you expect the medication to stop all this bad stuff or just some of it? If your medication is supposed to make your migraine go away, should you expect the pain to ease in five minutes? Five hours? Five days? Unless you know how — and how fast — your medication is supposed to act, you have no way to know if it’s working.

What should you do if you miss a dose?

In general, it depends on how much you miss it by, says Jeff Goad, associate professor at the USC School of Pharmacy. If you’re supposed to take a dose every eight hours and you remember half an hour late, it’s probably OK to take it right away and then resume your regular schedule with the next dose. On the other hand, if you don’t remember until half an hour before you’re due to take the next dose, you shouldn’t try to make up for the dose you missed. But medications vary, and it’s best to find out about your own specifically.

Should you keep taking the medication until it’s all gone or just until your symptoms go away?

It’s important to keep taking some medications, especially antibiotics, until you’ve used them all up, even if you feel better before that. You can take other medications only “as needed” — i.e., only when you’re experiencing the problem they’re supposed to treat. Other medications are for chronic conditions and are meant to be taken over the long term, perhaps for life.

Is it safe to stop taking the medication whenever you want?

If your medication is intended to make your broken arm hurt less and you stop taking it, your arm will probably hurt more — but probably nothing worse than that will happen. If your medication is an antibiotic intended to cure a bacterial infection and you stop taking it before you finish the full course, some bacteria will probably survive and multiply and may make you sick again. Plus you may be contributing to the rise of antibiotic resistance — since the bacteria that did survive (and multiply) will be the ones most resistant to the antibiotic.

It may be even less wise to stop taking other medications abruptly on your own. If you suddenly stop taking a medication meant to lower your blood pressure, for example, your blood pressure could spike dangerously.

What side effects should you watch out for?

In addition to the effects you want your medications to have — making your blood pressure go down or your energy level go up — drugs may have effects you’d rather they didn’t, such as making you fall asleep in a meeting with your boss. Some side effects are more common than others, and some are more serious. You need to know which are which, how you can avoid them (if possible) and what you can and should do about them if they occur. For example, the standard recommendation for medications that make you drowsy is to avoid driving or operating heavy machinery.

What interactions should you watch out for?

If you’re already taking any over-the-counter medications, herbal remedies, dietary supplements or other prescription drugs, or if you drink alcohol, your new medication might act in undesirable ways. It could be ineffective. It could be dangerous. There are ways to avoid some bad interactions, such as scheduling your doses appropriately. And there are times when the medications themselves should be avoided.

How should you store the medication?

Proper storage will ensure that your medication is as effective as possible. Usually this means in a cool, dry, dark place. Sometimes it means in the refrigerator or freezer. But for the most part it means not in the medicine cabinet in your bathroom, where conditions are often warm and moist.

Is there a way to save money on your prescription?

Physicians tend to underestimate the price of expensive drugs and overestimate the price of inexpensive ones, according to a study published in the journal PLoS Medicine in 2007. So they may not always have a very good idea of how much the drugs they prescribe are going to cost their patients. Often pharmacists can suggest changes or substitutions for prescribed medications that will save patients money.

In California, if your physician prescribes a brand-name drug and you’d rather take a less expensive generic, your pharmacist can make the substitution without consulting the prescribing physician. To change to a different drug, however, pharmacists do need the physician’s approval. Even with a hefty financial incentive, patients are sometimes reluctant to take their pharmacists’ advice.

“They think what their physicians prescribed must be better or they wouldn’t have prescribed it,” says Kathy Besinque, an associate professor at the USC School of Pharmacy who also works part-time at Patton’s Pharmacy in Santa Monica. “But really, physicians have many choices that would work.”

“Some patients assume generic drugs are less effective than brand names,” says Julie Donohue, associate professor in the graduate school of public health at the University of Pittsburgh. In fact, generics contain the same amounts of active ingredients as do the brand names they are meant to be substituted for.

“As a pharmacist myself, I would take generics,” says Ken Thai, owner of El Monte Pharmacy in El Monte.

Cost issues can affect people’s insurance coverage. “Sometimes insurance plans won’t cover new medications,” Besinque says. “They want patients to try old, less expensive ones first.”

Besides recommending less expensive medications, pharmacists can help patients save money in other ways too. For example, a pill that’s twice as strong as the one your physician prescribed usually doesn’t cost twice as much, Besinque says. So if the double-strength pill can be split in half, you can get the same amount of medication for less. Similarly, for medication you take long-term, you can often save money by buying more pills at once — e.g., 60 pills probably won’t cost twice as much as 30.

Does your pharmacy provide any special services that will make your life easier?

Some pharmacies can package your medication in daily doses, making it easier to take the right amounts. CVS Pharmacies recently began a free program to make it easier to refill prescriptions you take for chronic conditions. If you sign up for the new service, the store will simply refill any such prescriptions automatically — and then call you to let you know they’re ready.

Remember: It’s never too late, and it’s never too dumb.

If you get home and start taking your new medication and only then think of a bunch of questions about it, not to worry. “You can call your pharmacist with any question about your prescription at any time,” says Anne Burns, vice president for professional affairs for the American Pharmacists Assn. In fact, it’s just natural to have more — and possibly more important — concerns after you’ve taken the medication for a while.

In any case, “there are no bad questions,” Thai says. “The more communication people have with their physician and pharmacist, the better. When people don’t say anything, that’s when we run into problems.”

Even the most common medications pose threats

August 12, 2010 By: Nadia Category: Cholesterol, HealthCare, Medicine Advice, Medtipster, Prescription News Source: LA Times – Author: Karen Ravn

Here’s a look at five of the most-prescribed drugs and their possible risks, side effects and possible interactions.

Some drugs are so common that consumers — at their peril — don’t think twice about them. But each drug, whether prescription or over-the-counter, poses risks. To highlight these risks, we offer up a few details on five of the most-prescribed medications, with additional input from pharmacists interviewed for this package of stories.

Hydrocodone with acetaminophen

Brand names: Vicodin, Lortab

Description: A combination of a narcotic (hydrocodone) with a non-narcotic (acetaminophen) pain reliever, it’s prescribed for moderate to severe pain.

Most serious risks: Abuse and addiction; acetaminophen overdose. Too much acetaminophen can cause severe liver damage, even death, but many patients aren’t aware of this danger — or of how many medications contain acetaminophen. Acetaminophen is the active ingredient in Tylenol, but it’s also found in many other medications.

Possible side effects: Constipation, drowsiness, dizziness, nausea, vomiting, stomachache.

Common interactions: Barbiturate anesthetics (e.g., thiopental); cimetidine (Tagamet); antidepressants, including monoamine oxidase (MAO) inhibitors such as phenelzine (Nardil) and tricyclic antidepressants such as amitriptyline; sodium oxybate (GHB). These may lead to excessive sleepiness or create breathing difficulty.

And our pharmacists say . . . : This is probably one of the most abused drugs on the market. While taking this drug, avoid taking alcohol and other drugs that cause sleepiness. If you drive while taking it, you can be cited — and convicted — for driving under the influence. Check the labels of any other medications you are taking to see if they contain acetaminophen, and only take one source of acetaminophen at a time. Fluids and fiber can help prevent constipation, but you may also need to take laxatives. Taking this drug with food can reduce stomachache. The dizziness or drowsiness that can come with the drug can increase the risk of falls — a serious danger for older people.


Brand names: Prinivil, Zestril

Description: An ACE (angiotensin-converting enzyme) inhibitor, lisinopril improves blood flow by interfering with the production of angiotensin II, a substance that constricts blood vessels and releases hormones that raise blood pressure. It’s prescribed for high blood pressure and heart failure and to improve survival chances after heart attacks.

Most serious risks: Birth defects if taken while pregnant; hyperkalemia, a condition caused by high levels of potassium that can lead to an irregular heartbeat; nausea; slow, weak or nonexistent pulse; and even heart attacks. It is a particular risk in patients with poor kidney function.

Possible side effects: Nagging dry cough, dizziness. Less common but more severe: swelling of the face and lips, difficulty swallowing or breathing, itchiness.

Common interactions: Diuretics (may increase risk of low blood pressure); diabetes medications (may increase risk of low blood sugar); lithium (may increase lithium concentrations to toxic levels); potassium (may cause retention of potassium, so potassium supplements can lead to hyperkalemia); nonsteroidal anti-inflammatory drugs, such as ibuprofen or naproxen (these reduce the excretion of ACE inhibitors, so their concentration in the bloodstream increases).

And our pharmacists say . . . : This medication should never be used by pregnant women. ACE inhibitors are generally less potent in African Americans. Also, studies have shown that when taking lisinopril (or other ACE inhibitors), African Americans are at increased risk for angioedema (swelling similar to hives but under the skin and potentially life-threatening). Seniors too are at higher risk for angioedema. Also, if seniors are taking a diuretic and then start taking lisinopril too, their blood pressure may drop too quickly. It’s better to start with lisinopril and add the diuretic later. If you drink alcohol while taking lisinopril, that can also make your blood pressure drop too much. Because lisinopril suppresses your body’s ability to quickly adjust blood pressure, you could faint if you jump out of bed or stand up too fast. Avoid potassium supplements or salt substitutes containing potassium.


Brand name: Zocor

Description: Like other statins, simvastatin inhibits a particular liver enzyme (HMG Co-A reductase) to reduce the liver’s capacity for making cholesterol. It’s prescribed to reduce LDL cholesterol, often called “bad cholesterol.”

Most serious risks: Birth defects if taken while pregnant; (rarely) rhabdomyolysis, a severe breakdown of skeletal muscle that can lead to acute renal failure and death should myoglobulin (a muscle protein) leak into the blood or urine (making urine dark).

Possible side effects: Constipation or diarrhea, upset stomach, mild muscle or joint pain.

Common interactions: Digoxin (digitalis), warfarin (Coumadin), gemfibrozil, niacin, cyclosporine, danazol, verapamil, amiodarone. Simvastatin may increase the effects of digoxin and warfarin. The other drugs — as well as grapefruit or grapefruit juice — may increase the risk of muscle cramping, myopathy (muscle disease) and rhabdomyolysis.

And our pharmacists say . . . : When taking this drug, stick to your cholesterol-lowering diet — or you’ll defeat the purpose. Take at the same time every day, preferably at night. Do not take while pregnant. Do not drink grapefruit juice or eat large amounts of grapefruit. Avoid alcohol, which can raise triglyceride levels and possibly damage your liver. Muscle-related side effects are more likely in the elderly than in younger patients, and they may be more serious in the elderly, since they’re already declining in muscle strength. In addition, the link between statins and muscle pain is easy to miss in the elderly because they often have pain from other causes.


Brand names: Levothroid, Levoxyl, Synthroid, Unithroid

Description: A thyroid hormone, levothyroxine is prescribed for hypothyroidism, a condition in which the thyroid gland doesn’t produce enough thyroid hormone.

Most serious risks: High blood pressure, even a heart attack, if the dose is too high — or if someone with normal thyroid production takes it in an attempt to lose weight. The latter is especially dangerous for someone who’s also using amphetamines.

Possible side effects: Side effects are relatively rare because this is the same chemical the thyroid itself makes. But if the dose is too low, you may continue to have symptoms of hypothyroidism (e.g., fatigue, sluggishness, unexplained weight gain). If the dose is too high, you may develop symptoms of hyperthyroidism (e.g., sudden weight loss, increased appetite, nervousness or anxiety). Tell your physician immediately if you have chest pain or a rapid or irregular heartbeat or pulse.

Common interactions: If you take insulin or other diabetes medications, the correct dosage may change if you start taking levothyroxine. Many other medications can also interact with levothyroxine, including non- prescription drugs, vitamins, minerals and herbal supplements.

And our pharmacists say . . . : Take once a day in the morning on an empty stomach 30 minutes before breakfast or other medications. If you take iron, calcium or antacids (e.g., Mylanta, Maalox), you should take them at least four hours after levothyroxine. Scheduling can be a problem for seniors who take medication for osteoporosis, which also has to be taken by itself before breakfast. Talk to your physician or pharmacist to set up a schedule to make sure you take both. Levothyroxine is usually taken for life, although the dosage may change. (Get an annual blood check to determine if you’re at the right level.) Dosage may need adjustment during pregnancy. If you stop taking levothyroxine without medical supervision, serious complications can result. If you miss a dose accidentally, you can take it later in the day, but do not try to “make up” for it by taking an extra dose the next day. Small changes in your thyroid pill can cause large changes in thyroid levels in the blood. So you should continue to take the same brand that you start on and get stabilized on. Don’t shop around and change brands from month to month. Hypothyroidism can cause cognitive difficulties, and some patients admitted to nursing homes with a diagnosis of dementia can be “cured” by taking levothyroxine.


Brand names: Zithromax, Zitromax, Sumamed

Description: A macrolide antibiotic, azithromycin works by stopping the growth and reproduction of bacteria (as opposed to killing them directly). It’s in the erythromycin family and can be taken by patients who are allergic to penicillin. It’s prescribed for a wide range of bacterial infections.

Most serious risks: As are all antibiotics, the drug is completely ineffective against viral infections, yet it’s often prescribed without testing to see if an infection is viral or bacterial. This leads to widespread overuse that contributes to the growth of resistant bacteria — i.e., bacteria impervious to available antibiotics.

Possible side effects: Nausea, abdominal discomfort, vomiting, diarrhea.

Common interactions: Azithromycin may interact with a number of medications. Tell your physician or pharmacist about any other medications you take — including vitamins, nutritional supplements, herbal products and non-prescription drugs — in case your doses need to be changed.

And our pharmacists say . . . : Azithromycin is usually taken once a day for one to five days. This is a big plus in comparison to another popular antibiotic, amoxicillin, which is usually taken for seven to 10 days. But as with amoxicillin and all other antibiotics, you can’t stop taking it as soon as you start feeling better. You have to finish your prescription. Stopping early increases the risk that the infection could come back. If you take antacids (e.g., Maalox, Mylanta), take them at least two hours before, or four hours after, taking azithromycin. If you miss a dose, don’t double up. Take the next dose on time and continue on schedule until the prescription is gone. When patients with viral infections take an antibiotic, they may feel better four or five days later and assume it has worked — but really the infection has just run its course.

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