Generic Prescriptions- Worth the Price Break?

Many patients understandably prefer generic medications because of cost. Most physicians are very in tune with this, and will give you their honest opinion about which drugs seem to have clinically equal generics. In my personal clinical experience, I would broadly say that most generics are perfectly fine, but I see I higher rate of patient satisfaction with name brand products in hormones (primarily birth control and thyroid), certain migraine medications, and a few specific antidepressants. That being said, it is VERY patient specific- the only way to know if you tolerate a generic better or worse than a name brand is to try it. For example, while probably 95% of my patients who take sleep aids are happy with the generic, there is a subset that find a dramatic difference between that and name brand, from deriving a morning "hangover" with the generic to simply a decreased effectiveness.

The FDA requires that generic prescriptions have the same intended use, dosing, delivery system, and safety as the original drug. The active ingredients are the same, but there can be different byproducts in the generic which may cause a reaction.

Why do doctors ever write brand names on a prescription if they want you to have the generic? The answer is simpler than you might think- brand names are usually shorter. In fairness, doctors also have their "favorite" drugs, and we think of them often with their trade name. In the old days of drug company-sponsored elaborate trips and gifts, I'm sure physician "favorites" were indeed swayed by the pharmaceutical companies, but I can attest that the vast majority of doctors that I know and work with have "favorites" based on what WORKS for patients- combining effectiveness, side effects (good and bad), ease of dosing (the fewer doses per day or even week, the better), delivery system (shot vs. pill vs. patch or cream), and yes, COST.

BOTTOM LINE: Don't hesitate to ask your doctor what she thinks about the generic alternatives to your prescription medications, and together you will figure out which name brand medications are important for your health. 

Drug Abuse in Teens- from YOUR Medicine Cabinet

Prescription drug abuse is at an all time high- no pun intended. Sadly, studies have found that 1 in 5 high school students say they have taken a prescription drug without a prescription. What are they taking? Pain killers, stimulants, and anxiety medications. Specifically, the most common drugs are OxyContin & Percocet (narcotic pain pills), Ritalin & Adderall (ADD stimulant drugs), and Xanax (an anti-anxiety sedative like valium.)

It frankly terrifies me to hear of kids swapping prescription medications, particularly ones as potent as these. Add in that the pain and anxiety pills are usually combined with alcohol, and you now have a recipe to take your breath away- literally. Both narcotics and alcohol can suppress your drive to breathe, and they are additive when taken together. Accidental overdose is the second leading cause of death for teenagers, and inappropriately used prescription drugs are believed to be major culprit. There is often a false feeling of security with getting a buzz from a prescription drug. Surely, if a doctor prescribed it for her, then it is safe for me, right? Wrong.

What can parents do about this alarming trend? Number one, TALK to your teen and ask (in a non-threatening, conversational tone) if they are aware of anyone borrowing prescription medications from friends. Let them know this is dangerous, even when someone else is using the drug for the same reason it was prescribed in the first place (like friends sharing ADD meds to be able to focus better in class.) The reality is that although there is plenty of "altruistic" sharing of medications, most "sharing" is for side effects- the buzz of the narcotic or sedative, or the appetite suppressant effects of the ADD drugs. At any rate, talking with your teen lets them know you are aware of this risky behavior in general. Next step? Take a close look at your medication cabinet. Throw away expired drugs, and keep close inventory of any potentially abused medications. Finally, if you realize that you are using prescription drugs inappropriately, it's time for a difficult conversation with your physician. You can't abuse it if we don't prescribe it, so this is a problem we need to tackle together, and there are solutions beyond simply cutting you off.

BOTTOM LINE: Prescription drug abuse is out of control. Learn the facts and protect and educate your teens. Get more info at the National Institute on Drug Abuse.

Having Trouble Taking All Your Medications?

Today I'd like to say a few words about medications. Often physicians need to prescribe multiple medications for the same patient. One is each morning, another twice a day, a couple are "as needed" and yet another is recommended at bedtime. One must be taken with food, and another is restricted to an "empty stomach". Before you know it, our patient is supposed to take a half a dozen pills per day- at different times, and with different restrictions- and then we wonder why they are "noncompliant"!

In a perfect world, pills would not interact with each other or with meals, and they could be given once per day. In reality, many medications do not play well in the stomach together, and must be separated. What can we all do? Well, the basic pill box that has a separate compartment for each day is lovely. Don't feel you need to qualify for Medicare before you purchase one! I tell all my patients that there is a good reason "the pill" comes in a dispenser that is labeled by day. How many times have you wondered, "gee, did I take my pill today?" Well, the same is true for vitamins, calcium supplements, and prescription medications of all sorts.

Find a pill dispenser that works for you! If you have multiple medications, consider one that actually reminds YOU! There are wonderful contraptions that you can set up with a week or more of pills, and then an alarm will go off up to four times per day, letting you know that your pills are ready for you!

The picture above is the one I used for my memory-challenged father for several years with great success.

BOTTOM LINE: Don't rely on your memory- find a pill dispenser that works for you to simplify and increase your success with medication compliance!

You can find this pill dispenser at the online Alzheimer Store ; I have no financial ties to them, just really appreciate how this tool simplified MY life and improved my Dad's consistency with medications!

Got any COUGH syrup? Medicine Cabinet Staple #8

As I discuss what drugs most doctors keep in their medicine cabinets, the next medication that comes to mind is cough syrup.
I typically keep an over-the-counter cough syrup such as Robitussin DM or Triaminic Cough and Cold or the generic store equivalents. The primary ingredient you are looking for is the "DM"- the dextromethorphan. This is the cough suppressant portion. The other active ingredients tend to be decongestants and antihistamines. I usually pick the pure cough syrups rather than the cough and cold combo's, because I like to choose my own decongestants/antihistamines (to control side effects like sleepiness.)

Ever wonder why a medication would have an expectorant (guaifenisen) and a cough suppressant? What's up with that? Do you want to loosen it up and cough it out, or stop the cough? Well, actually, a combination is not bad. It stops the annoying little throat tickle type cough, but allows you to cough effectively to clear your lungs.

What about prescription cough syrups? Honestly, we usually have ONE bottle of some kind of codeine or hydrocodone cough syrup in the house, though typically I find it is expired when I reach for it in the middle of the night for a coughing family member! These are ADDICTIVE, so if you have a tendency towards preferring medications that give you a slight "buzz", this is NOT something you should keep around your home. If, however, you have developed a cough that is lasting all night long, preventing you and your bed partner from sleeping and leaving you with sore stomach muscles from all that coughing, a prescription cough syrup may be the right answer. Ask your doctor!

Also, please see "cough, cough, cough" for further discussion of why it is worth your time and effort to head to the doctor for a cough, even if it is from a cold (and therefore antibiotics will NOT help!)

BOTTOM LINE: Pick a cough syrup with DM from your pharmacy, and have it in your medicine cabinet this cough & cold season!

What IS this Pill?

Have you ever found a pill-perhaps on the floor of your bathroom, or in your teenager's room or in your car-and wondered what the heck type of pill it is? Or perhaps your mail order prescription arrives, and the pill doesn't look anything like the size, shape or color of the last prescription for the same drug, and you wonder if the pharmacy put the right "generic" equivalent in the bottle. What can you easily do at home to help identify the drug?

It turns out that there are multiple websites that can help you to identify what pill you are holding. My current favorite (which means that it worked the best the last time I tried to identify a stray pill) is http://www.drugs.com/imprints.php All you need to do is to enter in the color(s), shape, and any letters or numbers that you see printed or imbedded on the pill. The site then shows you any matches, including a picture that you can compare with the pill you are holding- voila!

So, if you tossed a bunch of different medications into one container for your last trip and now need to sort them out, or simply have found a stray pill, here is a beautiful use of the information highway. Click on the link above (or google "pill identifier" to pull up multiple sites) and save yourself a trip to the pharmacy!

BOTTOM LINE: Reliable websites are available to help you identify "stray" pills, whether they are over the counter or prescription.

I'd Like a Pill to Fix This...

Fast food medicine from a "doc in a box" seems to be the order of the day. We demand instant gratification. We text people because we don't want to wait for them to get out of a meeting. Worse, people answer these texts- while they are driving, and SHOULD be focused on the road.

Not surprisingly, people are demanding this same instant fix in medicine, and doctors are providing it. Got heartburn? Grab the purple pill. Can't sleep? Here's a sleeping pill. Too tired in the morning? Slam back a Starbucks. Caffeine and alcohol causing heartburn? Back to the purple pill! And...repeat.

Let me give a ridiculous example to illustrate my point. Say you decided it was fun to pick up a rock and hit your knee with it ten times per day (work with me, here.) Not surprisingly, your knee begins to hurt. You go to the doctor, and he or she prescribes a pain pill. Is this going to solve your problem? No, of course not! The problem is NOT the pain, the problem is you hitting your knee with a rock.

So, why is it any different when you go to your doctor with heartburn, and you get a prescription for an acid blocking pill instead of education to at least temporarily wean off caffeine, eliminate alcohol and nicotine, and avoid ibuprofen? (Hopefully, you'll get both, but I think we all know most people will pop the pills, get relief, and continue the habits that caused the problem.)

We've got to tackle this problem from both sides, and look for true solutions- not Band-Aids! Patients- ask your doctor if there are exercises or other behavior modifications that would help fix your problem before you try a prescription medicine. Please try NOT to ask for the pill that you saw on a commercial last week. Doctors- we need to spend the extra few minutes to offer these solutions, rather than grabbing our prescription pads immediately.

BOTTOM LINE: Many medical problems can be solved (and most improved) without taking a prescription, so make sure you understand the CAUSE of your medical issue so you can actively be part of the solution!