Tag Archives: Polypharmacy

Is Your Child on Multiple Meds? He May Be at Increased Risk for Adverse Events

When we think of drug interactions and adverse effects, we worry more about adults — and particularly seniors — who are often on a cocktail of drugs. But new research shows that children and teens are also at risk for adverse effects – some quite serious – from being on multiple drugs.

The study, published in September in the journal Pediatrics, found that one in five children is on regular prescription medication, and one in twelve is potentially at risk for serious side effects from two or more drugs interacting with each other. In particular, teen girls have a higher risk than boys.

In many cases, this happens when a child is on a chronic long-term medication, such as an antidepressant, birth control or an ADHD (attention-deficit/hyperactivity disorder) stimulant. He or she falls ill and is given an antibiotic, a short-term medication. At that point, there is the potential for those two drugs to interact and cause adverse effects.

The Risks of Using Multiple Drugs in Children

About 200,000 children (age 17 and younger) go to the ER each year as a result of an adverse drug event, according to the CDC. What wasn’t known before was how many children and teens were on prescription drugs, and how many were taking two or more at the same time — called concurrent use — and the risk from drug-to-drug interaction.

The researchers found that boys age six to 12 years old had the highest use of concurrent prescription drugs at 12%, followed by teen boys and girls at 10%.

Significantly, the risk of drug-to-drug interactions for teen girls on antidepressants was much higher at 18%, than for boys at almost 7%, because more teen girls were given antibiotics for infections.

The most common side effect seen with drug-drug interactions in the study was abnormal heart rhythm, with a risk of its leading to sudden death. It also found that the most commonly used combinations of drugs were associated with effects such as suicidal tendencies or depressive symptoms. These combinations include taking an antidepressant with at least one other psychotropic medication or a birth control pill.

What Parents Need to Know

Over-the-counter (OTC) pain and fever medicines and antacids can also potentially interact with antidepressants and other chronic drugs, the study authors pointed out.

“Parents need to be aware of these adverse effects, which are not typical but could happen for many reasons,” said Dima Qato, PharmD, MPH, PhD, associate professor of pharmacy at the University of Illinois, Chicago, and lead study author. “They need to be aware of the drugs that can cause it, which are not limited to prescription medicines, but can also be [OTC] analgesics and acid reflux drugs used to treat heartburn.”

If children see more than one doctor and they’re given different prescription drugs by different providers, parents need to inform their physicians and pharmacists about all drugs they’re on.

About 200,000 children (age 17 and younger) go to the ER each year as a result of an adverse drug event.

Sudden cardiac deaths are under-reported in children, but are more common among those who are athletes, have asthma or are on antidepressants.

“It’s a concern that children are taking medications that expose them to higher risk,” Qato cautioned. “We may not know, as physicians, pharmacists and school nurses, that this could happen.”

“We hope people will be more vigilant about giving children multiple medications, particularly teen girls,” she added.

Communication Key to Avoid Risk

“The study brings up some really good points,” said Siyi Yung, MD, a pediatrician and attending physician at the University of California, Los Angeles Mattel Children’s Hospital. “It shows how many kids are at risk for drug interactions. It’s definitely a problem, even if it’s not as prevalent as in elderly people. We need to be aware of it because of how often children go to the emergency room for adverse effects.”

But she cautioned that the study looked at potential interactions, not actual events that took place and were reported. These potential adverse effects are not common, but could happen.

“The potential is high, but in pediatrics, when we prescribe for a chronic period of time, we usually follow them very closely, especially if it’s an antidepressant, via phone or in-person,” Yung said. “When patients are already on chronic medication, and we are the ones prescribing an antibiotic, that is when it gets trickier.”

When an outside prescriber such as a psychiatrist writes up a prescription for an antidepressant, and communication between the doctor, the parents and the pediatrician is not clear, this can lead to gaps in knowledge which can complicate things, especially when the child is put on two or more drugs. Intake forms at clinics and hospitals always ask about current medications, but patients and caregivers can slip up and forget to list them all.

“Someone could come in for a urinary tract infection, forget to tell the doctor they’re also on antidepressants, and get antibiotics for their UTI, which could lead to a drug interaction,” Yung explained. “For many patients, their parents give us an oral report, but often can’t remember the name of the medicine, its potency, etc.”

System Improvements Needed

Part of the problem also lies with unnecessary prescriptions for antibiotics, which Yung said are often doled out when children are brought to the ER or urgent care, and seen by unfamiliar doctors. Antibiotics are only effective for bacteria-based infections. More than 60,000 children end up at the ER as a result of an adverse drug event from an antibiotic each year, according to the CDC.

“I think it drives home the need to improve our healthcare system so patients are not forced to go to the ER when they could be served by their normal clinic or primary care provider,” Yung said.

Similarly, for ADHD, when a parent raises concerns, there may be an explanation for a child’s behavior when physicians investigate, and maybe even contact the teachers, before prescribing drugs.

Parents also often start a child on OTC medicines without being aware of how they might interact with the chronic drugs the child is on, so it’s important to ask the doctor what medicines and supplements (including vitamins) should be avoided every time you meet with the doctor about the chronic drug, she said.

Seniors That Take Multiple Meds Have Higher Car Crash Risk

While it’s no surprise that many older adults take a lot of different medications, many of those drugs can potentially increase their risk of getting into an automobile accident.

A new report from the AAA Foundation for Traffic Safety found that nearly 50% of active senior drivers used seven or more medications. An analysis of 3,000 older drivers that also monitored the drugs they were taking found that about 20% of the meds should be avoided because of limited therapeutic benefit and/or potential to cause excess harm. These drugs are on a list known as the Beers Criteria.

These inappropriate drugs include benzodiazepines such as Xanax (alprazolam) and Valium (diazepam), as well as first-generation antihistamines. These medications can cause blurred vision and confusion and can impact coordination, increasing a driver’s crash risk by as much as 300%, according to AAA.

Some of the most commonly prescribed medications in this age group can affect driving ability. For example, 73% of respondents said they took a heart medication, and 70% said they took a central nervous system drug, such as a pain medication, stimulant or anti-anxiety drug.

The AAA Foundation said prior research found that less than 18% of senior drivers say they received a warning from their doctor that their medication could impact their driving ability.

Benzo, Opioid Combination in Alzheimer’s Patients Potentially Dangerous

About 20% of people with Alzheimer’s disease (AD) take both a prescription opioid and tranquilizer medication together, and that’s problematic as it can lead to serious risks.

Researchers say that AD patients who took a benzodiazepine, such as Xanax (alprazolam), Valium (diazepam) and Ativan (lorazepam), along with an opioid had a higher incidence of lung disease, osteoporosis and hip fracture in the past. They added that using benzodiazepines, which are often prescribed to seniors as sleep aids, while also taking an opioid can boost the risk for pneumonia, fractures and drug misuse.

Researchers based their findings, published in the International Journal of Geriatric Psychiatry, on data on more than 70,000 diagnosed with AD in Finland.

Both benzodiazepines and opioids are on the Beers Criteria, a list of drugs that are potentially inappropriate for seniors because their risks may outweigh their benefits.

“Concomitant use of drugs that act on the central nervous system in an older population is concerning, as the use of these drugs has been associated with serious risks, especially in frail individuals with AD,” lead author Niina Karttunen, University of Eastern Finland, said in a statement. “Unnecessary co-use of these drugs should be avoided, as the benefits rarely outweigh the risks.”

Quick Hits: FDA Cracks Down on Flavored E-Cigs, No CV or Cancer Benefit from Fish Oil and Vitamin D Supplements & More

The FDA is proposing new restrictions on the sale of flavored e-cigarettes as well as a ban on flavored cigars and menthol cigarettes as part of an effort to curb youth smoking and vaping. Under the agency’s proposal, flavored e-cig liquids and pods can only be sold in stores that have age-restricted entry or areas inside stores where those under 18 are not permitted. This essentially means that the products would only be available in vape and tobacco stores and not convenience stores and gas stations. In addition, the FDA will require “heightened age verification processes” for sales of flavored e-cigs online. The agency also released new data from its National Youth Tobacco Survey which showed that between 2017 and 2018, the number of high school students using e-cigarettes increased by 78%. There was a 48% increase among middle school students. About 3.6 million high school and middle school students currently use e-cigarettes. Last year, that figure was 2.1 million. Posted November 15, 2018. Via FDA.

Taking omega-3 fatty acid (fish oil) and vitamin D supplements isn’t any better than taking a placebo at preventing major cardiovascular events, such as heart attacks and strokes, or cancer. In a study, researchers recruited 25,871 healthy people 50 and older. They were then given either a fish oil supplement, vitamin D supplement, both supplements or a placebo. Participants were followed for an average of about five years. Results showed that taking fish oil supplements did not result in lower rates of cardiovascular events or cancer compared to placebo. Likewise, taking vitamin D pills didn’t result in a lower incidence of cardiovascular events or cancer compared to placebo. Secondary findings did indicate that those on fish oil pills had a 28% lower risk of heart attack, and there were fewer cancer deaths among those on vitamin D pills for at least two years. Posted November 10, 2018. Via New England Journal of Medicine.

Half of older patients are prescribed medications that may be inappropriate. This puts seniors at greater likelihood of experiencing adverse drug events, reduced quality of life and an increased risk of emergency room visits and hospital stays. A new study, which looked at older patients in Ireland, also found that a hospital stay is associated with an increased risk of being inappropriately prescribed medication. The potentially inappropriate prescribing is due to adding medications to existing regimens and neglecting to stop or at least reduce dosages of drugs after discharge from hospital. The study’s authors say better coordination of care, especially for seniors who have many medical conditions, can help to reduce the risk of medication errors, adverse drug events and readmission to the hospital. Posted November 14, 2018. Via BMJ.

Many Medications Taken Longer Than Recommended

Many people continue to take prescription drugs months after clinical guidelines recommend, a practice that increases the risk of side effects from individual drugs as well as from drug interactions.

New research examines the issue of legacy prescribing, which is when drugs are taken for longer than needed to treat a condition. A new study, published in the Annals of Family Medicine, examined 50,000 patients in Canada who were prescribed drugs that are typically taken for more than three months but not indefinitely. The drug classes were antidepressants; proton-pump inhibitors (PPIs), which are used to treat heartburn and acid reflux; and bisphosphonates, which treat osteoporosis by stemming bone density loss.

Nearly half of patients on an antidepressant – 46% – were on it for more than 15 months, even though a current recommendation states they should be prescribed it for only six months after a mood episode is resolved. PPIs shouldn’t be taken for longer than three months. However, 45% of patients were prescribed them for longer than 15 months. The recommendation for bisphosphonate prescriptions is 5.5 years, yet 14% of people on those drugs took them for at least six months longer than that.

For example, long-term use of PPIs has been linked to several health issues. In one study, patients who had taken the drugs for at least five years had a higher risk of developing kidney disease than those on another type of acid-reducing medication. Another study found long-term PPI use may be associated with an increased risk for stomach cancer.

Talking to Your Pharmacist Can Help Cut Down Your Meds

Deprescribing of inappropriate medications to seniors is more effective if pharmacists work with doctors and patients are educated about potentially harmful medications they are taking. Deprescribing is reducing the dose of or eliminating a medication that is no long necessary or may cause harm.

About 29% of Medicare beneficiaries aged 65 and older have filled a prescription that is on the Beers Criteria, a list of drugs compiled by the American Geriatrics Society that seniors should avoid because their risks outweigh their benefits. Examples include certain antihistamines, benzodiazepines (Ativan, Xanax) and sleep medications (Ambien, Lunesta).

About 500 seniors in Canada took part in a study along with their pharmacists. In order to be included in the trial, a participant needed to have taken one of the following Beers Criteria medications for at least three months: benzodiazepines (sedative medications) or prescription sleep drugs; first-generation antihistamines; Glynase (glyburide), a diabetes drug, and certain non-steroidal anti-inflammatory drugs (NSAIDs) that are used as pain relievers.

The seniors were divided into two groups. One group received a brochure about why a medication they were taking might be appropriate and some alternative options. Pharmacists in that group also received fillable PDF forms that they could send to a patient’s doctor suggesting that a medication was inappropriate and should be deprescribed. The other seniors and pharmacists did not receive any educational materials or other type of intervention.

After six months, 43% of seniors in the intervention group stopped filling a prescription for an inappropriate drug compared to 12% in the control group, according to results published in JAMA. The greatest difference was found in those who were taking a sedative or sleep drug. About 43% of seniors who received educational materials and pharmacist intervention stopped using those medications compared to just 9% of the other group.

“Interventions that engage patients, physicians, and pharmacists in the deprescribing process may be more effective than interventions that do not,” Michael A. Steinman, MD, and C. Seth Landefeld, MD, of, respectively, University of California San Francisco and University of Alabama at Birmingham, wrote in an accompanying editorial. “Given the inertia that accompanies long-term medication use, it is often insufficient to motivate only one of these groups to make a change.”

Can Artificial Intelligence Predict Drug Side Effects?

Marinka Zitnik is a postdoctoral computer science researcher at Stanford University with an interest in how artificial intelligence (AI) can help in the field of medicine. When she came across statistics about how taking multiple medications can lead to experiencing many side effects, she decided to do something about it.

She wondered if an AI system could mine information about these drug combinations and predict their potential side effects, which could then be used by prescribers as a tool to evaluate the risks of prescribing a particular cocktail of drugs.

The more drugs someone is taking, the more likely the risk of drug-drug interactions. Physicians prescribing the drugs cannot predict all the possible side effects that could occur because there is so much that is unknown about potential adverse effects from combining drugs.

The Problem of Polypharmacy

In the US, studies show that about 40% of adults over the age of 65 take five or more medicines, up from about 13% back in the late 1980s. Called polypharmacy, it’s most common among seniors, but is also prevalent among adults with intellectual disability and, increasingly, even among children and teens with certain conditions.

Zitnik learned that it’s difficult to perform experiments on a large scale to get reliable information on potential side effects from drug combinations, given there are more than 5,000 drugs on the US market, which makes it impossible to test different combinations of all these drugs.

Zitnik and her Stanford colleagues say that there are 1,000 known drug side effects, meaning there are 125 billion possible side effects if all potential drug pairs are considered.

“We don’t know much about how they interact, and we spend nearly $200 billion on treating the side effects,” she said, quoting a Journal of Pharmacy study.

When Zitnik and her colleagues embarked on this project, they found there was no existing model that could test for polypharmacy side effects. So they took data from the FDA Adverse Event Reporting System (FAERS) database and used it to develop algorithms. Their AI system, Decagon, first learns about side effects, becoming familiar with them. It then can predict them by studying how the drugs interact with the body’s 19,000 proteins.

“We get the adverse effects data, then training [of the system] happens in several rounds. In every round, the model makes predictions, we look at errors in the predictions and we change” information about the drugs and side effects “so that in the next round the predictions are more accurate,” Zitnik explained. “This is repeated many times until the model learns…well and can accurately predict side effects.”

It currently has about 80% accuracy in predicting side effects, which it ranks according to the top 50 possible drug interactions. The researchers’ goal at this stage is to clinically validate the predictions made by Decagon, by looking for real-life patient experiences that are comparable. The next step will be refining the system and making it user friendly for prescribers.

AI’s Potential Impact on Reducing Side Effects

“I don’t see how most prescribers can even begin to scratch the surface in understanding the potential for drug interactions,” said Dave Walker, RPh, a pharmacy veteran in Oregon who used to manage pharmacies for hospitals and grocery chains and owned his own store. “Deprescribing needs to happen, because less is better. I’ve seen people taking 18, even 27 medications from multiple prescribers.”

He said the Decagon system could have a significant impact on predicting and reducing adverse effects, for one main reason.

“In pharmacology and pharmacy, they don’t have the resources or time to analyze this for every patient. If we have an automated system doing this, I see a lot of good coming from it,” Walker, who also serves on MedShadow’s Medical Advisory Board, said.

Jeannene Strianse, PharmD, director of pharmacy at Stony Brook University Hospital in New York, finds Decagon to be an interesting approach to a critical problem.

“The older you get, the more drugs you are on, for various reasons,” Strianse said. “When we look at patients that are on multiple drugs, patients 65 and older tend to be on an average of 10 drugs each.”

Stony Brook Hospital has three pharmacists review drugs a patient is taking to see if any can be taken out of the mix. They also look at databases for drug-drug interactions to see if changes are necessary. In this way, they can stop using secondary drugs that are often used to treat the side effects from particular drug combinations.

“Drugs seem to be the quick answer to things,” she pointed out. “The AI system can help patients and physicians make informed decisions in starting a new drug, but they need to be careful because it’s an idea of what might potentially happen — which may not happen.”

She cautioned that side effects often occur only in a small number of people, depending on genetic and other factors, so in a doctor-patient discussion, it needs to be discussed as “it may happen, but probably won’t happen.”

Strianse said that the system can have a lot of potential to improve care once it’s further validated, and will be one more tool in the physician’s tool box to determine what the risk is in prescribing a specific drug to a patient.

“This system will be able to say, based on how two drugs interact, that it could cause liver failure, but it can’t say if that will happen to you, me or someone else,” Strianse said. “It can just tell you there’s a potential risk, so that’s what the physician and patient need to understand — that it can’t predict exact risk, but it’s still more information than they had before.”

What’s Next for Decagon

Zitnik’s team is now collaborating with medical schools at Columbia University and Stanford to improve the model and test it so it’s accurate enough to be used in the real world.

The medical schools will look at electronic health records to see what drugs patients are on, the side effects they experience, and how that coincides with Decagon’s predictions.

“If Decagon predicts that a blood pressure lowering drug and another drug could lead to tachycardia [rapid heartbeat], they will see if there are patients who have experienced this, which then validates our system,” Zitnik said.

What she hopes to achieve with Decagon is to create user-friendly tools that provide guidance for doctors to help them make better decisions in prescribing drug combinations. Patients should also be able to enter the drug combinations they’re taking so Decagon can predict the side effects they should watch out for. Zitnik also wants to make it useful for clinical researchers, so they can develop drug therapies that have fewer side effects.

Quick Hits: FDA Raids E-Cig Manufacturer, Asthma Drugs’ Side Effects & More

The FDA conducted a surprise inspection of JUUL Labs as part of the agency’s effort to gain more information on the e-cigarette company’s sales and marketing practices. The FDA reportedly seized more than 1,000 documents. The action comes just weeks after the FDA ordered JUUL and four other manufacturers to come up with plans to curb use of e-cigs by teens. JUUL has the largest share of the e-cig market, and its sales grew more than seven-fold from 2016 to 2017, according to newly released data from the CDC (Centers for Disease Control and Prevention). The CDC also noted that JUUL has among the highest nicotine content of e-cigs available. Posted October 2, 2018. Via CDC.

More than half of people with asthma that take oral steroids such as prednisolone experience significant side effects, according to a new survey. Asthma UK, a charitable organization, interviewed 1,200 patients with severe asthma, most of whom had at least two asthma attacks in the prior year and were on an oral steroid. Of those on a steroid, about 56% experienced weight gain, 55% had trouble falling asleep, 43% were more irritable and more easily upset. And 37% said they were more anxious and had less energy. Asthma UK said that healthcare providers should use newer biologic-based drugs known as monoclonal antibodies to treat asthma, as they have been shown to reduce asthma attacks by up to 50%. Some of these medications include Xolair (omalizumab), Cinqair (reslizumab) and Nucala (mepolizumab). However, they are more expensive than oral steroids. Posted October 2, 2018. Via The Times.

About 20% of people with Alzheimer’s disease use two or more psychotropic drugs that can raise the risk of experiencing adverse events. Researchers in Finland examined the medical records of more than 70,000 people diagnosed with the disease. Antipsychotics were eight times as likely to be prescribed in those with Alzheimer’s compared to those without the disease. The use of at least two psychotropics together was three times more common among people with Alzheimer’s. The most common combination was an antidepressant with either an antipsychotic or benzodiazepine, a class of medications used for anxiety and sleep. Use of acetylcholinesterase inhibitors, a first-line dementia treatment, such as Aricept (donepezil), was associated with less risk for psychotropic polypharmacy, while use of Namenda (memantine), another dementia drug, was associated with a higher risk. Posted October 1, 2018. Via European Neuropsychopharmacology.

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Quick Hits: FDA Threatens E-Cig Manufacturers, Elderly Polypharmacy and Falls & More

Saying youth smoking of e-cigarettes is reaching “epidemic proportions,” the FDA has ordered the manufacturers of the 5 top e-cigarettes to come up with plans on how to curb use by teens. The agency also threatened to pull flavored e-cigarettes – which are especially appealing to young people – from the market if they can’t demonstrate how they can keep the devices away from children. The manufacturers receiving letters are Juul Labs Inc., Vuse, MarkTen XL, Blu and Logic. Data from Nielsen Research indicates that Juul has more than two-thirds of the e-cigarette market. About 2.1 million middle and high school students used e-cigarettes last year, according to the CDC. Over the summer, the FDA said it issued more than 1,300 warning letters and fines to retailers who illegally sold e-cig products to minors as part of an undercover operation, the largest coordinated enforcement effort in the agency’s history. Posted September 12, 2018. Via FDA.

Elderly people that take several medications for sleeping, pain or incontinence are twice as likely to fall and suffer broken bones compared to those not taking any drugs. Researchers analyzed data on more than 70,000 older adults living in New Zealand. Those who were taking more than 3 Drug Burden Index medications – drugs that sedate or affect one’s cognition – were twice as likely to break their hip than those on no drugs, researchers reported in the Journals of Gerontology. Between 20% and 30% of those who broke their hip died within a year. Lead author Hamish Jamieson, PhD, of the University of Otago, Christchurch, New Zealand, said that multiple medications can cause falls in the elderly because of side effects in each of the medications and drug-drug interactions than can create additional side effects. Posted September 11, 2018. Via University of Otago.

The FDA has issued warning letters to 2 companies for making unsubstantiated medical claims in selling products containing the herb kratom. The agency says that Chillin Mix Kratom and Mitra Distributing make claims that their kratom products can relieve opioid withdrawal and treat conditions including depression, anxiety and high blood pressure. The FDA noted that kratom may contain substances that contain opioids and the plant may have a high potential for abuse. Over the last year, the FDA has issued several public warnings about potential dangers associated with kratom. In February, the agency said it identified 44 deaths associated with the use of kratom. Posted September 11, 2018. Via FDA.

Quick Hits: Imodium Abuse, Polypharmacy and Hospitalization & More

The FDA is requesting that the over-the-counter anti-diarrhea medicine Imodium (loperamide) be packaged differently to prevent abuse. There have been numerous reports indicating that people have intentionally misused and abused high doses of the treatment as a substitute for opioid drugs. In some cases, this has led to serious heart problems and death. In order to rectify this problem, the agency sent a letter to manufacturers asking that they limit the amount of drug per package for short-term use. For instance, a package could contain 8 2-milligram capsules, which would be enough for about 2 days. Posted January 30, 2018. Via FDA.

Taking 5 or more drugs increases hospitalization risk among older adults both with and without HIV. Yale researchers collected data from the Veterans Aging Cohort Study and analyzed adults with and without HIV who received at least 1 medication in 2009. The research team analyzed the patients, who were around 50 years old, over the course of 6 years. The results of the study indicated that older people — both with and without HIV — who took multiple drugs simultaneously had a greater risk of being hospitalized or dying. Posted January 30, 2018. Via AIDS.

The boxed warning on 2 classes of asthma medications has been removed. The warning on long-acting beta-agonists (LABAs) and inhaled corticosteroids (ICS) that cautioned consumers about asthma-related death was removed after the FDA reviewed 4 large clinical trials and found that treating asthma with LABAs in combination with ICS does not cause more serious asthma-related side effects (such as hospitalization, the need for a breathing tube, or asthma-related deaths) than treatment with ICS alone. Posted December 20, 2017. Via FDA.

Many Patients Prescribed Drugs of Little Benefit Months Before Death

During their waning months of life, many elderly patients are often given many medications that may serve little or no benefit to them, yet carry the potential for serious adverse events and drug-drug interactions.

Researchers in Sweden examined the prescription drug history of nearly 500,000 elderly people in the 12 months before they died. They found that in that final year, almost half — 47% — were taking at least 10 prescription drugs, they reported in the American Journal of Medicine. Those taking cancer drugs had the largest increase of drugs taken over the course of their final year.

While many patients were given drugs such as pain relievers to relieve symptoms of medical conditions, they also continued to take medications that are considered long-term preventative treatments, such as beta blockers used for heart conditions, ACE inhibitors for high blood pressure and statins to reduce cholesterol. The researchers questioned whether patients close to death should continue to take drugs whose clinical benefits would not be achieved before they passed away.

“Physicians should consider discontinuing drugs that may be effective and otherwise appropriate, but whose potential harms outweigh the benefits that patients can reasonably expect before death occurs,” the researchers noted. They added that “the process of de-prescribing requires timely dialogue between the patient, family, and physician, and close monitoring of symptoms.”

The authors also called for the development of clinical guidelines to help physicians reduce potentially futile drug treatments near the end of life.

Be the Boss of Your Medicine

Nearly half of parents admit they don’t understand how and when to give their children asthma medicine. How is that OK with parents?

Asthma meds aren’t unusually confusing. If this study was expanded to drugs for diabetes, heart issues or whatever, I bet the results would be the same. How is that OK with anyone?

Medicine given at the wrong time or in the wrong dosage is much worse than useless: Too much could trigger adverse events  — side effects — that aren’t expected and might not be recoverable. Too little and the drug is ineffective. In short, you could be killing your child or yourself by over- or under-medicating.

And yet it’s easy to make mistakes, particularly if taking more than one pill or supplement. Instructions are given by the health care provider often when the patient isn’t feeling well or is worried. It might seem clear in the office, but at home questions arise. Over time, instructions might be not be remembered. What can you do? Ask questions.

Questions to Ask

Here are typical and good questions to ask even if you’ve been taking a medicine (or several) for years:

For short-term drugs: Should I finish the bottle or stop when I feel better? If there are refills authorized, should I refill and continue taking?

If you’re taking more than one medicine or if you’re taking supplements and vitamin pills too, make sure to ask if you can take them all at once or if you have to take them separately.

If you don’t feel that the medicine is making you better, call your doctor before you stop taking it. It might need some time to be effective or there might be a better medicine out there for you. Get the care you need.

Add a Routine

Make taking needed medicines part of your routine. Include them as part of your bedtime or morning routine. Set a daily alarm on your phone to remind you or try an app if you have several times a day to take different pills.

Put medicines where you’ll see them when you need them. If you take them with food, then put the pill bottle on your dinner table. If in the morning, next to your coffee or tea pot. Pills don’t have to live in your medicine cabinet. In fact, that’s a bad place to store medicines because of the humidity and because they are accessible to anyone.

If you confuse your pills, keep them in different places and in different color containers. Put your own sticky label on the jar. Or place your pills in daily dosing containers (the kind with the days of the week on them).

If you’re not taking your medicines because they make you feel nauseous/constipated/headachey/tired, tell your doctor. Sometimes you can easily avoid those side effects by taking them with food, or a full glass of water, or caffeine or before bed.

Don’t Skip Because of Cost — Ask Your Pharmacist

If you can’t afford your medicines, tell your healthcare provider and your pharmacist. There might be less expensive alternatives or a program for discounts on your med from the pharmaceutical company. Many states have drug assistance programs.

Whatever you are prescribed, be aware that medicines are strong chemicals that will interact with your body’s systems. You want to maximize the benefits and minimize the side effects.

Remember, it’s not OK to be unsure about when and how to take or give medicines. Take medicine correctly so it can do its job to keep you (or get you) healthy.