In your daily pill box, you’ve got blood pressure medication, calcium supplements, thyroid meds and baby aspirin. You take some in the morning, some with food and some when you finally remember. But is that safe or effective? You could be unknowingly flushing money down the drain – or worse. Here, pharmacists suggest 10 easy rules for taking prescriptions…
Are you making the most of your medications? Drug effectiveness relies not only on the prescription, but how and when you take it.
Taking medications at the wrong time or mixing them with the wrong foods or supplements may lower drug effectiveness or cause side effects. In fact, you could seriously harm yourself.
“It's like playing a deadly game of Russian roulette if you don't educate yourself about the medications you take,” says Suzy Cohen, R. Ph., Lifescript expert and author of Drug Muggers and The 24 Hour Pharmacist (Harper).
Almost 45% of negative drug reactions are caused by taking prescriptions incorrectly, according to a 2005 study cited by the federal Agency for Healthcare Research and Quality.
We asked doctors and pharmacists for guidelines on taking medications properly:
1. Know food rules.
“It’s usually OK if you eat something with your medication, but there are a few exceptions,” says pharmacist Nancy Nkansah, Pharm. D., an assistant professor of clinical pharmacy at University of California, San Francisco.
For example, some prescription prenatal vitamins and osteoporosis or thyroid medications work better on an empty stomach.
But nonsteroidal anti-inflammatory drugs (NSAIDs) and many other pills, such as some antibiotics and vitamins, are better tolerated or absorbed when taken with food.
With many drugs prescribed for anxiety, depression, cholesterol and more, for example, you may have to eliminate grapefruit, grapefruit juice and pomelos from your diet. That’s because these fruits contain chemicals called furanocoumarins. They interfere with enzymes that help metabolize some medications, potentially causing your medication blood levels to get dangerously high.
To learn which foods interfere with the drug’s effectiveness, read medication guidelines and instructions carefully.
2. Time your doses.
Many medications should be taken at certain times of the day to ensure drug effectiveness, says Michael Smolensky, Ph.D., adjunct professor of biomedical engineering at the University of Texas at Austin and author of The Body Clock Guide to Better Health (Holt Paperbacks).
For example, taking blood pressure medication at night, rather than in the morning, may better control hypertension and significantly decrease the risk of heart attack and stroke, according to a 2010 study published in the journal Chronobiology International.
That’s so the hypertension medications can be fully absorbed and potent by the time blood pressure starts to rise naturally in the morning.
Similar timing applies to many cholesterol medications, acid blockers for reflux and asthma medications. These work with an enzyme that’s more active at night.
But check with your doctor to see if there’s a particular time of day that’s better for the drug’s effectiveness.
3. Correctly dispose of unused medications.
What do you do with leftover or expired prescriptions? Flush them down the toilet? It’s not a good move, because trace amounts of drugs have been discovered in lakes, rivers and water supplies.
Ask if your pharmacy will take back unused and expired medication, so they can dispose of them safely.
Or check with the city or county waste disposal department for a drug take-back program. For more information, check out http://www.smarxtdisposal.net.
If you strike out with the pharmacy and community programs, the Food and Drug Administration (FDA) offers these medication guidelines: Take drugs out of the bottle, place them in a bag or container that can be sealed, and mix in trash such as kitty litter or coffee grounds. Seal the container and discard with trash.
4. Ask a pharmacist or physician before taking medications with supplements.
Some vitamins and herbs change how long drugs stay in your system, affect drug effectiveness and interfere with absorption, says Nkansah.
This is particularly true if you’re taking medications like antibiotics or osteoporosis drugs, which are best ingested at least two hours before or after vitamins. And if you’re on a blood thinner, for example, gingko or garlic can interfere with blood clotting, warns Nkansah.
“If we know which supplements someone is taking, we can predict the likelihood of a problem and discuss alternatives,” Nkansah says.
5. Follow dosing recommendations.
Don’t take your whole dose in the morning if instructions say take twice or three times daily, advises internist Robert R. Recker, M.D., professor of medicine at Creighton University in Omaha, Neb.
“If you take some medications or supplements all at once, you risk overwhelming the absorption capacity of the gut,” and your medications might not work effectively, he explains.
What should you do if you forget to take a pill?
“In most situations, take it as soon as you realize,” says Candice Garwood, Pharm.D., clinical assistant professor of pharmacy at Wayne State University in Detroit, Mich.
“But if it’s nearly time for the next dose, don’t take two doses together,” she advises. “Instead, forget about the dose missed, and continue with your usual schedule.”
In some cases, you should double the dose. If you miss a birth control pill, take two tablets the next day, she says.
If you’re not sure what to do, read the insert included with the medication or call your pharmacist.
“Don't be timid about asking your pharmacist a question,” Cohen advises. “They’re drug information specialists and do their best to keep you safe.”
6. Don’t pharmacy-hop.
With the high cost of prescription drugs, it’s tempting to use multiple pharmacies to find discounts.
But that’s a bad idea because “no one is fully aware of all your prescriptions,” and you risk duplicate dosing or serious interactions, Garwood says.
Stick with one pharmacy to keep a record of all prescriptions in one place.
7. Don’t abandon prescriptions.
Drugs costing more than $50 were almost five times more likely to be left at the pharmacy than cheaper medications, according to a study published in 2010 in the journal Annals of Internal Medicine.
New users were far more likely not to pick up their prescriptions than those who had previously taken the drug.
Ignoring your medication – and health problem – isn’t a treatment plan; in fact, your condition may get worse.
For example, people who weren’t diligent about taking their blood pressure medication had more arterial stiffness, a leading risk factor for stroke and heart attack, according to a study published in the European Journal of Internal Medicine.
If you can’t afford your meds, want to make a change or are uneasy about taking them, call your doctor or talk with a pharmacist for options.
8. Don’t take other people’s medications.
Your sister offers you the drug she’s taking for hot flashes or your spouse shares sleeping pills. What’s the harm? you think.
A lot, actually. The dosage may not be right for you, or it may interact with your body or other medications you’re taking.
“If a person takes the wrong medication, there can be inadvertent side effects,” Nkansah adds.
9. Don’t split un-scored pills.
You risk overmedication and stomach irritation, warns Nkansah.
Extended-release or sustained-release pills aren’t scored for splitting because they’re formulated to slowly release medication in the body.
Similarly, enteric coated or safety coated medications, such as coated aspirin, are made to be absorbed in a slower, more stomach-friendly way.
Splitting such pills interferes with the purpose of the coating, allowing the medication to be dissolved too quickly.
10. Don’t drink alcohol with many medications.
Painkillers and blood pressure medications make two glasses of wine feel like four or more.
Some diabetes drugs, particularly meglitinides or sulfonylureas, lower blood glucose levels by making more insulin. Alcohol also causes blood glucose levels to drop, which could send it to dangerously low levels.
If you plan to have a small amount of alcohol like a glass of wine, wait at least an hour for your body to metabolize the alcohol before taking medications, advises Nkansah.
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