Medications: Safe and Healthy Use

Here are five questions to ask yourself to improve your personal drug safety. If you have an elderly parent, consider answering these questions for them too. (This discussion is taken from Patrick Malone’s book, The Life You Save: Nine Steps to Finding the Best Medical Care — and Avoiding the Worst.)

1. How many drugs are you taking? An enormous problem, especially for older Americans, is taking too many drugs at one time, because these drugs can have dangerous interactions with each other or with other things you consume like alcohol, caffeine, and grapefruit juice. (Yes, grapefruit juice. It powerfully alters the way that the liver processes many drugs and generally should not be taken by anyone who has to use prescription drugs every day, unless your doctor or pharmacist says it’s okay.)
2. Do you have an up-to-date list of all your medications? You should always use the same pharmacy if you can, because its computer can automatically flag possible bad interactions among the prescriptions you’ve had filled there. This list of medications is so important that Dr. Sidney Wolfe makes it his first rule on his list of ten rules for safer drug use. He calls it having a “brown-bag session” with your primary doctor. You throw all your pill bottles in a brown bag—and don’t forget over-the-counter drugs and dietary supplements, anything you take regularly—and take them to the doctor’s office. Then, together, you fill out a drug worksheet that lists every drug, how and when you take it, what for, and problems to watch out for. You can also do this with your pharmacist.
3. Do you really need all those medications? The next step in safer drug use is to make sure you need all those drugs in your brown bag. Mildly high blood pressure, anxiety, mild adult-onset diabetes, and constipation are some of the most notorious ailments that lead to overuse of drugs. Eating right, exercising daily, and other good health habits can eliminate the need for a lot of these. Also, a drug might have helped you for a few months, but maybe you no longer need it. That’s why regular review of all your drugs with your doctor is important. Obviously, you need a doctor’s advice before you throw away any pills.
4. Are you candid with your doctor? If a drug doesn’t seem to work or it causes some strange new symptom, a lot of people will stop taking the drug without telling the doctor, sometimes out of a misplaced fear of hurting the doctor’s feelings. As with every other aspect of health care, total honesty is the only way to win good care.
5. Have you had a bad reaction to a new medication? One other thing you should know is to keep your antennae up for a bad reaction, especially in the first few weeks you’re on a new drug. It’s a good idea to assume that any new symptom you develop after starting a new drug might be caused by that drug, and you should call the doctor immediately. Some adverse drug reactions can be nipped in the bud this way. One especially tragic reaction that I’ve seen several times in clients is tardive dyskinesia: permanent, uncontrollable shaking and other movements in the face, arms, or legs. Another is an allergic burn of the skin and mucous membranes (lips, nostrils, eyelids, etc.), called Stevens-Johnson syndrome, which can be fatal if it goes too far.

Some bad reactions to drugs can be subtle, especially in older people. Many of us assume that Grandpa’s mind is getting foggy because of old age, when it really might be from the fistful of drugs he swallows every day. Depression can also be caused by drugs. The best gift you might give an elderly parent who seems to be “losing it” could be to take them to an appointment with a doctor who specializes in geriatrics for a comprehensive drug review.